Healthcare Provider Details

I. General information

NPI: 1114067816
Provider Name (Legal Business Name): SUZETTE ROHRER CDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N CLEVELAND AVE SUITE 1
WINSTON SALEM NC
27101-4366
US

IV. Provider business mailing address

7305 OAK PARK CT
PFAFFTOWN NC
27040-9721
US

V. Phone/Fax

Practice location:
  • Phone: 336-631-2330
  • Fax: 336-631-2340
Mailing address:
  • Phone: 336-922-9297
  • Fax: 336-631-2340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number144118
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: