Provider Demographics
NPI:1255748091
Name:HELMICK, SUSSAN ANNITA (DDS)
Entity type:Individual
Prefix:MRS
First Name:SUSSAN
Middle Name:ANNITA
Last Name:HELMICK
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 1:1812 DURHAM DR STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-2256
Mailing Address - Country:US
Mailing Address - Phone:832-673-0999
Mailing Address - Fax:281-657-2406
Practice Address - Street 1:1812 DURHAM DR STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-2256
Practice Address - Country:US
Practice Address - Phone:832-673-0999
Practice Address - Fax:281-657-2406
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX300881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX30088Medicaid