Provider Demographics
NPI:1699982538
Name:RISMANI, SUZAN (DDS)
Entity type:Individual
Prefix:DR
First Name:SUZAN
Middle Name:
Last Name:RISMANI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-4431
Mailing Address - Country:US
Mailing Address - Phone:717-249-7777
Mailing Address - Fax:717-249-3614
Practice Address - Street 1:30 STATE AVE
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-4431
Practice Address - Country:US
Practice Address - Phone:717-249-7777
Practice Address - Fax:717-249-3614
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030287L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1699982538Medicaid