Provider Demographics
NPI:1275835316
Name:WARREN, SUZANNE MARIE (RDH BS LAP)
Entity Type:Individual
Prefix:MISS
First Name:SUZANNE
Middle Name:MARIE
Last Name:WARREN
Suffix:
Gender:F
Credentials:RDH BS LAP
Other - Prefix:MRS
Other - First Name:SUZANNE
Other - Middle Name:MARIE
Other - Last Name:ROGGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH BS LAP
Mailing Address - Street 1:1870 SCARLET SAGE LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MT
Mailing Address - Zip Code:59044-9317
Mailing Address - Country:US
Mailing Address - Phone:406-530-1402
Mailing Address - Fax:
Practice Address - Street 1:1614 GOLDEN BLVD
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6592
Practice Address - Country:US
Practice Address - Phone:406-530-1402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1237124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist