Provider Demographics
NPI:1063432565
Name:PEDOTT, SUSAN KAYE (DMD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:KAYE
Last Name:PEDOTT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1218 SW MILITARY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-1535
Mailing Address - Country:US
Mailing Address - Phone:610-216-9609
Mailing Address - Fax:281-232-9890
Practice Address - Street 1:5020 FM 1960 RD W
Practice Address - Street 2:STE. B1
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-4519
Practice Address - Country:US
Practice Address - Phone:610-216-9609
Practice Address - Fax:281-232-9890
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030073-L1223E0200X
TX245001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics