Provider Demographics
NPI:1811181704
Name:CASHIER-COZZA, SUSAN DENISE (RDHAP #189)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:DENISE
Last Name:CASHIER-COZZA
Suffix:
Gender:F
Credentials:RDHAP #189
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 NELSON ST
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3419
Mailing Address - Country:US
Mailing Address - Phone:805-481-6435
Mailing Address - Fax:
Practice Address - Street 1:515 NELSON ST
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3419
Practice Address - Country:US
Practice Address - Phone:805-481-6435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12552124Q00000X
CA189124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist