Healthcare Provider Details

I. General information

NPI: 1780800441
Provider Name (Legal Business Name): AMY E SUHR DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 N. MAIN ST. TUBA CITY REGIONAL HEALTH CARE, DENTAL DEPARTMENT
TUBA CITY AZ
86045
US

IV. Provider business mailing address

PO BOX 1494
TUBA CITY AZ
86045-1494
US

V. Phone/Fax

Practice location:
  • Phone: 928-283-2672
  • Fax:
Mailing address:
  • Phone: 716-536-1120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number15122
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: