Provider Demographics
NPI:1770987992
Name:AHN, SUZANNE BUSUN (DDS)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:BUSUN
Last Name:AHN
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 1:728 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-2017
Mailing Address - Country:US
Mailing Address - Phone:518-346-6429
Mailing Address - Fax:518-346-8495
Practice Address - Street 1:728 PLANK RD
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-2017
Practice Address - Country:US
Practice Address - Phone:518-346-6429
Practice Address - Fax:518-346-8495
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044148122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist