1760524169 NPI number — DR. SUSAN KATHRYN SEMAIN-OLES DMD

Table of content: DR. SUSAN KATHRYN SEMAIN-OLES DMD (NPI 1760524169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760524169 NPI number — DR. SUSAN KATHRYN SEMAIN-OLES DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEMAIN-OLES
Provider First Name:
SUSAN
Provider Middle Name:
KATHRYN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760524169
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4423 E MOONLIGHT WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85253-2838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-951-4264
Provider Business Mailing Address Fax Number:
480-951-2409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4350 E CAMELBACK RD
Provider Second Line Business Practice Location Address:
G-150
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85018-2701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-840-2190
Provider Business Practice Location Address Fax Number:
602-808-0820
Provider Enumeration Date:
02/13/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  D32823 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)