Provider Demographics
NPI:1205057619
Name:MILLAR, SUSAN FLORRIE (DDS)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:FLORRIE
Last Name:MILLAR
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 1:1503 S COAST DR
Mailing Address - Street 2:200
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-1534
Mailing Address - Country:US
Mailing Address - Phone:714-546-3000
Mailing Address - Fax:
Practice Address - Street 1:1503 S COAST DR
Practice Address - Street 2:200
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1534
Practice Address - Country:US
Practice Address - Phone:714-546-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD403771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice