Provider Demographics
NPI:1649340803
Name:ROBERGE, SUSAN ALISON (DDS)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ALISON
Last Name:ROBERGE
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 1:505 RIVERWAY PL
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6766
Mailing Address - Country:US
Mailing Address - Phone:603-622-3445
Mailing Address - Fax:603-624-4340
Practice Address - Street 1:505 RIVERWAY PL
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6766
Practice Address - Country:US
Practice Address - Phone:603-622-3445
Practice Address - Fax:603-624-4340
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH19781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice