Provider Demographics
NPI:1427735463
Name:SUSAN M. CABLE, DDS, SC
Entity type:Organization
Organization Name:SUSAN M. CABLE, DDS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CABLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-697-0321
Mailing Address - Street 1:5707 75TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-3603
Mailing Address - Country:US
Mailing Address - Phone:262-697-0321
Mailing Address - Fax:262-697-0312
Practice Address - Street 1:5707 75TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-3603
Practice Address - Country:US
Practice Address - Phone:262-697-0321
Practice Address - Fax:262-697-0312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty