Healthcare Provider Details

I. General information

NPI: 1154975076
Provider Name (Legal Business Name): PATRICIA ROSE SUING DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2019
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S WHITE MOUNTAIN RD
SHOW LOW AZ
85901-6112
US

IV. Provider business mailing address

401 S WHITE MOUNTAIN RD
SHOW LOW AZ
85901-6112
US

V. Phone/Fax

Practice location:
  • Phone: 928-527-5005
  • Fax:
Mailing address:
  • Phone: 928-537-5005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD011970
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD11096
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: