Provider Demographics
NPI:1023160678
Name:WILLIAMS, SUZANNE SMITH (DMD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:SMITH
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6214 OLD FRANCONIA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-3400
Mailing Address - Country:US
Mailing Address - Phone:703-719-6158
Mailing Address - Fax:703-719-6344
Practice Address - Street 1:6214 OLD FRANCONIA RD
Practice Address - Street 2:SUITE A
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3400
Practice Address - Country:US
Practice Address - Phone:703-719-6158
Practice Address - Fax:703-719-6344
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010082101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice