Provider Demographics
NPI:1487768750
Name:HAWLEY, SUSAN A (DDS)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:A
Last Name:HAWLEY
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 1:1221 S ORTONVILLE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:ORTONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48462-8676
Mailing Address - Country:US
Mailing Address - Phone:248-627-3933
Mailing Address - Fax:248-627-9367
Practice Address - Street 1:1221 S ORTONVILLE RD
Practice Address - Street 2:SUITE D
Practice Address - City:ORTONVILLE
Practice Address - State:MI
Practice Address - Zip Code:48462-8676
Practice Address - Country:US
Practice Address - Phone:248-627-3933
Practice Address - Fax:248-627-9367
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI16321122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist