Provider Demographics
NPI:1811907140
Name:BRACKER, SUSAN L (DDS)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:L
Last Name:BRACKER
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 1:6 HEARTHSTONE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-1118
Mailing Address - Country:US
Mailing Address - Phone:585-387-9314
Mailing Address - Fax:
Practice Address - Street 1:1 SAREDON PL
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-4070
Practice Address - Country:US
Practice Address - Phone:585-225-5600
Practice Address - Fax:585-225-6032
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50-0410451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice