MEDICARE: ROBERTA A SUHR DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center		OK

General Provider Information

NPI Number	:	1326560160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERTA A SUHR DDS

Provider Business Mailing Address
First Line	:	PO BOX 415
Second Line	:
City	:	MILLERTON
State	:	OK
Zip	:	74750-0415
Country	:	US
Telephone Number	:	580-746-2238
Fax Number	:

Provider Business Practice Location Address
First Line	:	16333 W US HIGHWAY 70
Second Line	:
City	:	VALLIANT
State	:	OK
Zip	:	74764-5598
Country	:	US
Telephone Number	:	580-746-2238
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ DENTIST
Name	:	DR. ROBERTA ANN SUHR
Credential	:	DDS
Telephone Number	:	580-746-2238

Provider Enumeration Date	:	07/13/2017
Last Update Date	:	07/13/2017

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