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General NPI Number Information
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NPI Number | 1093380883
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Entity Type | Individual
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Provider Name | SUSANNA FISENKOVA DDS
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Gender | Female
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Dates
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Enumeration Date | 05/24/2021
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Last Update Date | 07/26/2022
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Provider Practice Location Address
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Address Line | 2685 TITTABAWASSEE RD
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City | SAGINAW
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State | MI
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Zip | 48604-8217
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Country | US
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Telephone | 989-755-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 30430 FOX CLUB CT
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City | FARMINGTON HILLS
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State | MI
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Zip | 48331-1943
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Country | US
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Telephone | 248-773-9174
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2951000869
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License Number State | MI
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