Provider Demographics
NPI:1184729667
Name:BUCK-WISCHMEIER, SUSAN JEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JEAN
Last Name:BUCK-WISCHMEIER
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 1:44-123 MIKIOLA DR
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2437
Mailing Address - Country:US
Mailing Address - Phone:808-235-7743
Mailing Address - Fax:
Practice Address - Street 1:COMDT US COAST GUARD
Practice Address - Street 2:2100 2ND ST. SW SUITE 5314
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20593-0001
Practice Address - Country:US
Practice Address - Phone:808-842-2930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15377122300000X
MND11054122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist