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General NPI Number Information
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NPI Number | 1053549915
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Entity Type | Individual
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Provider Name | SUZANNA R AGUILERA DMD
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Gender | Female
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 09/18/2016
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Provider Practice Location Address
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Address Line | 999 PEACHTREE ST NE SUITE 700
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City | ATLANTA
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State | GA
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Zip | 30309-3915
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Country | US
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Telephone | 404-537-5224
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Fax |
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Provider Business Mailing Address
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Address Line | 4617 GLORY MAPLE TRCE
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-6431
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Country | US
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Telephone | 678-656-8754
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN013891
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License Number State | GA
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