Provider Demographics
NPI:1750574331
Name:JUNCO, SUSANA C (DMD)
Entity type:Individual
Prefix:MRS
First Name:SUSANA
Middle Name:C
Last Name:JUNCO
Suffix:
Gender:F
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:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079
Mailing Address - Country:US
Mailing Address - Phone:704-821-7222
Mailing Address - Fax:704-821-4510
Practice Address - Street 1:136 INDIAN TRAIL RD
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079
Practice Address - Country:US
Practice Address - Phone:704-821-7222
Practice Address - Fax:704-821-4310
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC84651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice