Provider Demographics
NPI:1740346808
Name:GUIRGUIS, SUSAN (DDS)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:GUIRGUIS
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 1:2710 PIEDMONT AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-2936
Mailing Address - Country:US
Mailing Address - Phone:218-525-5100
Mailing Address - Fax:
Practice Address - Street 1:2710 PIEDMONT AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-2936
Practice Address - Country:US
Practice Address - Phone:218-525-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND115591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice