Healthcare Provider Details

I. General information

NPI: 1235348657
Provider Name (Legal Business Name): SUSAN LYNN ZERRAHN D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2993 MAIN ST SUITE 2
PERU NY
12972-0343
US

IV. Provider business mailing address

PO BOX 343 2993 MAIN ST., STE. #2
PERU NY
12972-0343
US

V. Phone/Fax

Practice location:
  • Phone: 518-643-8080
  • Fax: 518-643-8484
Mailing address:
  • Phone: 518-643-8080
  • Fax: 518-643-8484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number052872
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: