Provider Demographics
NPI:1124466552
Name:SERGIE, SUSAN ANN (DMD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ANN
Last Name:SERGIE
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 1:2020 ABBOTT RD STE 1
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-4624
Mailing Address - Country:US
Mailing Address - Phone:907-344-2483
Mailing Address - Fax:907-349-2489
Practice Address - Street 1:2020 ABBOTT RD STE 1
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-4624
Practice Address - Country:US
Practice Address - Phone:907-344-2483
Practice Address - Fax:907-349-2489
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKDEND1500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist