Provider Demographics
NPI:1982166591
Name:SUSEK, RYAN J (DMD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:J
Last Name:SUSEK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 DUNMORE ST
Mailing Address - Street 2:
Mailing Address - City:THROOP
Mailing Address - State:PA
Mailing Address - Zip Code:18512-1147
Mailing Address - Country:US
Mailing Address - Phone:570-262-0187
Mailing Address - Fax:
Practice Address - Street 1:400 DUNMORE ST
Practice Address - Street 2:
Practice Address - City:THROOP
Practice Address - State:PA
Practice Address - Zip Code:18512-1147
Practice Address - Country:US
Practice Address - Phone:570-262-0187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0419211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice