Provider Demographics
NPI:1174972749
Name:THERESE SUSIENKA DMD PLLC
Entity type:Organization
Organization Name:THERESE SUSIENKA DMD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:C
Authorized Official - Last Name:SUSIENKA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-860-8491
Mailing Address - Street 1:22 GALAXY PASS
Mailing Address - Street 2:UNIT A
Mailing Address - City:SUTTON
Mailing Address - State:MA
Mailing Address - Zip Code:01590-4836
Mailing Address - Country:US
Mailing Address - Phone:508-372-0019
Mailing Address - Fax:
Practice Address - Street 1:22 GALAXY PASS
Practice Address - Street 2:UNIT A
Practice Address - City:SUTTON
Practice Address - State:MA
Practice Address - Zip Code:01590-4836
Practice Address - Country:US
Practice Address - Phone:508-372-0019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18565471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty