Provider Demographics
NPI:1356572598
Name:REESE, SUSAN RAE (RDH)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:RAE
Last Name:REESE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:RAE
Other - Last Name:BELKNAP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:115 E 6TH ST S
Mailing Address - Street 2:
Mailing Address - City:LADYSMITH
Mailing Address - State:WI
Mailing Address - Zip Code:54848-1910
Mailing Address - Country:US
Mailing Address - Phone:715-532-5531
Mailing Address - Fax:715-532-7899
Practice Address - Street 1:115 E 6TH ST S
Practice Address - Street 2:
Practice Address - City:LADYSMITH
Practice Address - State:WI
Practice Address - Zip Code:54848-1910
Practice Address - Country:US
Practice Address - Phone:715-532-5531
Practice Address - Fax:715-532-7899
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6091-016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist