Healthcare Provider Details

I. General information

NPI: 1760642052
Provider Name (Legal Business Name): SUSAN DIANE STEADY RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN POE STEADY REGISTERED DENTAL HY

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 VETERANS AVE
BILOXI MS
39531-2410
US

IV. Provider business mailing address

12320 CORRIES PLACE
GULFPORT MS
39503
US

V. Phone/Fax

Practice location:
  • Phone: 228-523-5103
  • Fax: 228-523-4310
Mailing address:
  • Phone: 228-523-5103
  • Fax: 228-523-4310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2351
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: