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General NPI Number Information
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NPI Number | 1306388244
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Entity Type | Individual
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Provider Name | SUSAN MEDINA RDH
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Gender | Female
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Dates
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Enumeration Date | 11/09/2016
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Last Update Date | 11/09/2016
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Provider Practice Location Address
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Address Line | 1062 STATE RT 38 SUITE 120
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City | OWEGO
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State | NY
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Zip | 13827
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Country | US
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Telephone | 607-687-8595
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 120 1062 STATE RT 38
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City | OWEGO
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State | NY
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Zip | 13827
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Country | US
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Telephone |
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 022904
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License Number State | NY
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