Provider Demographics
NPI:1881811164
Name:WINANS, SUZANNE KLUH (DDS)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:KLUH
Last Name:WINANS
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 1:5523 COUNTRYSIDE BEACH DR NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-3628
Mailing Address - Country:US
Mailing Address - Phone:360-790-9999
Mailing Address - Fax:
Practice Address - Street 1:872 SUSSEX AVE E
Practice Address - Street 2:
Practice Address - City:TENINO
Practice Address - State:WA
Practice Address - Zip Code:98589-9287
Practice Address - Country:US
Practice Address - Phone:360-264-2353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA9980122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA11180OtherWDS PPO DELTA
WA1632476OtherUNITED CONCORDIA
WA5046818Medicaid
WA785WIOtherREG BLUESHIELD
WA11180OtherWDS FFS DELTA PREMIER