Provider Demographics
NPI:1255448999
Name:OKULY, SUZANNE MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:MARIE
Last Name:OKULY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SUZANNE
Other - Middle Name:MARIE
Other - Last Name:NEIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:23 ANCIENT BND
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-1640
Mailing Address - Country:US
Mailing Address - Phone:210-317-7058
Mailing Address - Fax:210-949-8904
Practice Address - Street 1:8410 DATAPOINT DR
Practice Address - Street 2:SOUTH TEXAS VETERANS HEALTH CARE SYSTEM AUDIE L. MURPHY
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3220
Practice Address - Country:US
Practice Address - Phone:210-949-8900
Practice Address - Fax:210-949-8904
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15652122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist