Healthcare Provider Details

I. General information

NPI: 1730193517
Provider Name (Legal Business Name): SUSAN ANN SHEETS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 W GRAND AVE STE B2
EL SEGUNDO CA
90245-4243
US

IV. Provider business mailing address

2515 S WESTERN AVE STE 109
SAN PEDRO CA
90732-4643
US

V. Phone/Fax

Practice location:
  • Phone: 628-758-7563
  • Fax:
Mailing address:
  • Phone: 310-832-2657
  • Fax: 310-832-5164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number36196
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number36196
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number36196
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: