Provider Demographics
NPI:1912294414
Name:ANDERSON, SUSAN GS (DMD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:GS
Last Name:ANDERSON
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 1:6501 RED HOOK PLZ
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-1305
Mailing Address - Country:US
Mailing Address - Phone:340-513-2705
Mailing Address - Fax:
Practice Address - Street 1:6501 RED HOOK PLZ
Practice Address - Street 2:SUITE 201
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-1305
Practice Address - Country:US
Practice Address - Phone:340-513-2705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI937122300000X
MO2004030197122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist