Provider Demographics
NPI:1134341159
Name:PARKANZKY, SUSAN (DDS)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:PARKANZKY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40400 ANN ARBOR RD E
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-6615
Mailing Address - Country:US
Mailing Address - Phone:734-656-0400
Mailing Address - Fax:734-656-0402
Practice Address - Street 1:40400 ANN ARBOR RD E
Practice Address - Street 2:SUITE 203
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-6615
Practice Address - Country:US
Practice Address - Phone:734-656-0400
Practice Address - Fax:734-656-0402
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010118501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4053094Medicaid