Provider Demographics
NPI:1568210953
Name:SEXAUER, SUSANA (RDH)
Entity type:Individual
Prefix:
First Name:SUSANA
Middle Name:
Last Name:SEXAUER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:SUSANA
Other - Middle Name:
Other - Last Name:SEXAUER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OMT
Mailing Address - Street 1:3855 FOOTHILLS RD STE C
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4772
Mailing Address - Country:US
Mailing Address - Phone:505-660-2558
Mailing Address - Fax:
Practice Address - Street 1:3855 FOOTHILLS RD STE C
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4772
Practice Address - Country:US
Practice Address - Phone:505-660-2558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH3507124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist