Provider Demographics
NPI:1881941094
Name:SUESS, JEREMY C (DDS)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:C
Last Name:SUESS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10001 SE SUNNYSIDE RD
Mailing Address - Street 2:STE 250
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5746
Mailing Address - Country:US
Mailing Address - Phone:503-786-3000
Mailing Address - Fax:
Practice Address - Street 1:10001 SE SUNNYSIDE RD
Practice Address - Street 2:STE 250
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5746
Practice Address - Country:US
Practice Address - Phone:503-786-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD94911223G0001X
WADE 601726631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice