Provider Demographics
NPI:1750700068
Name:KAVON, SUSAN E (RDH)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:E
Last Name:KAVON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 COUNTRY CLUB AVE
Mailing Address - Street 2:
Mailing Address - City:PLENTYWOOD
Mailing Address - State:MT
Mailing Address - Zip Code:59254-1500
Mailing Address - Country:US
Mailing Address - Phone:406-765-2035
Mailing Address - Fax:406-765-2035
Practice Address - Street 1:130 COUNTRY CLUB AVE
Practice Address - Street 2:
Practice Address - City:PLENTYWOOD
Practice Address - State:MT
Practice Address - Zip Code:59254-1500
Practice Address - Country:US
Practice Address - Phone:406-765-2035
Practice Address - Fax:406-765-2035
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-RDH-LIC-416124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist