Provider Demographics
NPI:1356433874
Name:KLOBUCARICH, SUSAN SCHUSTER (DDS)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:SCHUSTER
Last Name:KLOBUCARICH
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 1:2001 S MATTHIAS ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-7229
Mailing Address - Country:US
Mailing Address - Phone:920-739-5822
Mailing Address - Fax:
Practice Address - Street 1:2001 S MATTHIAS ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-7229
Practice Address - Country:US
Practice Address - Phone:920-739-5822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54870151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics