Provider Demographics
NPI:1780932103
Name:FISCHARD, SUZANNE WARD (DDS)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:WARD
Last Name:FISCHARD
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 1:951 SKYLINE LN SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-0985
Mailing Address - Country:US
Mailing Address - Phone:612-219-6816
Mailing Address - Fax:
Practice Address - Street 1:720 MAIN ST
Practice Address - Street 2:SUITE 213
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55118-3757
Practice Address - Country:US
Practice Address - Phone:651-209-9219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13158122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist