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General NPI Number Information
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NPI Number | 1255481248
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Entity Type | Individual
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Provider Name | SUSAN LOUISE LUFT-MARCOTTE D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 30903 WEST TEN MILE RD. SUITE A
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City | FARMINGTON HILLS
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State | MI
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Zip | 48336-2609
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Country | US
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Telephone | 248-426-0077
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Fax | 248-426-9316
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Provider Business Mailing Address
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Address Line | 3674 SHALLOW BROOK DR
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48302-1449
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Country | US
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Telephone | 248-426-0077
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Fax | 248-426-9316
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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 | 2901016944
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License Number State | MI
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