Healthcare Provider Details

I. General information

NPI: 1962662817
Provider Name (Legal Business Name): SUSAN ELIZABETH SAVOY RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN HINES WILLIAMS RDH

II. Dates (important events)

Enumeration Date: 06/13/2008
Last Update Date: 05/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BAVARIA DENTAL ACTIVITY CREDENTIALS OFFICE CMR 475
APO AE
09036
US

IV. Provider business mailing address

1759 VZ COUNTY ROAD 2705
MABANK TX
75147-5483
US

V. Phone/Fax

Practice location:
  • Phone: 499318897714
  • Fax: 499318897714
Mailing address:
  • Phone: 806-729-8781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number4985
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: