Provider Demographics
NPI:1487891875
Name:VERBIS, SUSANA (DMD)
Entity type:Individual
Prefix:
First Name:SUSANA
Middle Name:
Last Name:VERBIS
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 1:717 LARKSPUR CT
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-3836
Mailing Address - Country:US
Mailing Address - Phone:707-373-1992
Mailing Address - Fax:
Practice Address - Street 1:717 LARKSPUR CT
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-3836
Practice Address - Country:US
Practice Address - Phone:707-373-1992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA578201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice