Provider Demographics
NPI:1588770291
Name:DUNN, SUSAN MARGARET (DDS)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARGARET
Last Name:DUNN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:MARGARET
Other - Last Name:VALADIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:11723 MAUMELLE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6558
Mailing Address - Country:US
Mailing Address - Phone:501-753-3100
Mailing Address - Fax:501-753-4505
Practice Address - Street 1:11723 MAUMELLE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72113-6558
Practice Address - Country:US
Practice Address - Phone:501-753-3100
Practice Address - Fax:501-753-4505
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3642122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR166534608Medicaid