Provider Demographics
NPI:1366723645
Name:DAVIS, SUSAN (RDHAP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7071 WARNER AVE
Mailing Address - Street 2:SUITE F370
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-5495
Mailing Address - Country:US
Mailing Address - Phone:714-907-6874
Mailing Address - Fax:888-412-2470
Practice Address - Street 1:7071 WARNER AVE
Practice Address - Street 2:SUITE F370
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-5495
Practice Address - Country:US
Practice Address - Phone:714-907-6874
Practice Address - Fax:888-412-2470
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP 366124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist