Provider Demographics
NPI:1184996035
Name:SUSAN S. ALTMAN, D.M.D. P.S.C.
Entity type:Organization
Organization Name:SUSAN S. ALTMAN, D.M.D. P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:SLONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-437-4848
Mailing Address - Street 1:419 TOWN MOUNTAIN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-1631
Mailing Address - Country:US
Mailing Address - Phone:606-437-4848
Mailing Address - Fax:606-437-4848
Practice Address - Street 1:419 TOWN MOUNTAIN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1631
Practice Address - Country:US
Practice Address - Phone:606-437-4848
Practice Address - Fax:606-437-4848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6195122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4500355500Medicaid
KY60061959Medicaid