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General NPI Number Information
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NPI Number | 1134575004
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Entity Type | Organization
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Legal Business Name | DR. SUESS FAMILY DENTAL PC
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Dates
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Enumeration Date | 05/10/2016
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Last Update Date | 05/10/2016
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Provider Practice Location Address
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Address Line | 10001 SE SUNNYSIDE RD STE 250
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City | CLACKAMAS
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State | OR
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Zip | 97015-5746
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Country | US
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Telephone | 503-786-3000
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Fax | 503-786-3501
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Provider Business Mailing Address
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Address Line | 10001 SE SUNNYSIDE RD STE 250
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City | CLACKAMAS
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State | OR
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Zip | 97015-5746
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Country | US
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Telephone | 503-786-3000
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Fax | 503-786-3501
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEREMY C SUESS
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Credential | DDS
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Telephone | 503-786-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | D9491
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License Number State | OR
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