Provider Demographics
NPI:1649602228
Name:COUZENS, SUSAN HALE (DMD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:HALE
Last Name:COUZENS
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 NEW ORLEANS RD STE A
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29928-4797
Mailing Address - Country:US
Mailing Address - Phone:843-785-6285
Mailing Address - Fax:843-785-8206
Practice Address - Street 1:21 NEW ORLEANS RD STE A
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29928-4797
Practice Address - Country:US
Practice Address - Phone:843-785-6285
Practice Address - Fax:843-785-8206
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7025122300000X, 332B00000X
SC101261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC10126OtherSOUTH CAROLINA DENTAL LICENSE