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General NPI Number Information
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NPI Number | 1467507061
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Entity Type | Individual
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Provider Name | DR. SUSAN MCBETH
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Gender | Female
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 12/29/2023
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Provider Practice Location Address
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Address Line | 500 N DIXIELAND RD SUITE 1
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City | ROGERS
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State | AR
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Zip | 72756-3212
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Country | US
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Telephone | 479-621-8229
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Fax | 479-621-6724
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Provider Business Mailing Address
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Address Line | 4417 W GORE BLVD STE 11
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City | LAWTON
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State | OK
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Zip | 73505-5978
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Country | US
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Telephone | 479-366-0938
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 234
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License Number State | OK
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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 | 90
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License Number State | AR
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