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General NPI Number Information
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NPI Number | 1225004195
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Entity Type | Individual
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Provider Name | SUSAN ELLEN VICKERS DMD,MS
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Gender | Female
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Dates
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Enumeration Date | 02/28/2006
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Last Update Date | 03/28/2017
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Provider Practice Location Address
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Address Line | 6512A DEER POINTE DR
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City | SALISBURY
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State | MD
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Zip | 21804-1669
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Country | US
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Telephone | 410-749-0009
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Fax |
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Provider Business Mailing Address
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Address Line | 29913 WINCHESTER CT
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City | SALISBURY
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State | MD
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Zip | 21804-2401
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Country | US
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Telephone | 410-334-6632
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 12543
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 12543
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License Number State | MD
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