Provider Demographics
NPI:1336237510
Name:KIRALY, SUSAN A (MS, DDS, FAGD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:A
Last Name:KIRALY
Suffix:
Gender:F
Credentials:MS, DDS, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:FRIDAY HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98250-9311
Mailing Address - Country:US
Mailing Address - Phone:360-378-5550
Mailing Address - Fax:360-370-5192
Practice Address - Street 1:815 SPRING ST
Practice Address - Street 2:
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250-9311
Practice Address - Country:US
Practice Address - Phone:360-378-5550
Practice Address - Fax:360-370-5192
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA76171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA602263331OtherSTATE UNIFIED BUSINESS ID
65-1169730OtherFEDERAL TAX ID