Provider Demographics
NPI:1942468921
Name:SUSAN SALES DENTAL CORPORATION
Entity type:Organization
Organization Name:SUSAN SALES DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ENCARNACION
Authorized Official - Last Name:SALES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-871-2741
Mailing Address - Street 1:1001 SNEATH LN
Mailing Address - Street 2:STE. 108
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-2308
Mailing Address - Country:US
Mailing Address - Phone:650-871-2741
Mailing Address - Fax:650-871-2781
Practice Address - Street 1:1001 SNEATH LN
Practice Address - Street 2:STE. 108
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-2308
Practice Address - Country:US
Practice Address - Phone:650-871-2741
Practice Address - Fax:650-871-2781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39736261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental