Provider Demographics
NPI:1972761054
Name:KOO, SUSAN H (DDS)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:H
Last Name:KOO
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 1:4618 FIREWHEEL DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-5105
Mailing Address - Country:US
Mailing Address - Phone:972-675-9430
Mailing Address - Fax:
Practice Address - Street 1:5435 N GARLAND AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-2785
Practice Address - Country:US
Practice Address - Phone:972-530-7374
Practice Address - Fax:972-530-7636
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX169751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice