Provider Demographics
NPI:1336127125
Name:MAGRAW, SUSAN JOAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JOAN
Last Name:MAGRAW
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 1:1320 BABCOCK BLVD E
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-2809
Mailing Address - Country:US
Mailing Address - Phone:763-972-6574
Mailing Address - Fax:763-972-8503
Practice Address - Street 1:1320 BABCOCK BLVD E
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-2809
Practice Address - Country:US
Practice Address - Phone:763-972-6574
Practice Address - Fax:763-972-8503
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN86091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice