Provider Demographics
NPI:1174695605
Name:LEBON, SUSAN SUTTER (DDS)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:SUTTER
Last Name:LEBON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 NAPOLEON AVE
Mailing Address - Street 2:SUITE 605
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-6357
Mailing Address - Country:US
Mailing Address - Phone:504-899-5400
Mailing Address - Fax:504-899-5405
Practice Address - Street 1:2633 NAPOLEON AVE
Practice Address - Street 2:SUITE 605
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-6357
Practice Address - Country:US
Practice Address - Phone:504-899-5400
Practice Address - Fax:504-899-5405
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA35631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice