Provider Demographics
NPI:1962554428
Name:MCCORMICK, SUZANNE U (MS, DDS)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:U
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:MS, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 SANTA FE DR
Mailing Address - Street 2:SUITE100
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5132
Mailing Address - Country:US
Mailing Address - Phone:760-753-5300
Mailing Address - Fax:
Practice Address - Street 1:355 SANTA FE DR
Practice Address - Street 2:SUITE100
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5132
Practice Address - Country:US
Practice Address - Phone:760-753-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA507041223S0112X
NY0427621223S0112X
WV28671223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery