Provider Demographics
NPI:1366558405
Name:AMATRUDI, SUSAN LYNN (DMD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LYNN
Last Name:AMATRUDI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 STATE ROAD 13 STE 4
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-2993
Mailing Address - Country:US
Mailing Address - Phone:904-230-2961
Mailing Address - Fax:904-230-1627
Practice Address - Street 1:485 STATE ROAD 13 STE 4
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-2993
Practice Address - Country:US
Practice Address - Phone:904-230-2961
Practice Address - Fax:904-230-1627
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN134301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice