Provider Demographics
NPI:1912998295
Name:DANDO, SUSAN (DO)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:DANDO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:HOEFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:12303 DEPAUL DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044
Mailing Address - Country:US
Mailing Address - Phone:314-344-7049
Mailing Address - Fax:314-344-7073
Practice Address - Street 1:12303 DEPAUL DR
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044
Practice Address - Country:US
Practice Address - Phone:314-344-7049
Practice Address - Fax:314-344-7073
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODO2005022495207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology