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General NPI Number Information
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NPI Number | 1497984124
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Entity Type | Individual
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Provider Name | SUZANNE ELIZABETH CLEARY RDH
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Gender | Female
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Dates
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Enumeration Date | 07/02/2009
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Last Update Date | 07/02/2009
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Provider Practice Location Address
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Address Line | 5270 W BASELINE RD STE 130
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City | LAVEEN
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State | AZ
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Zip | 85339-6959
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Country | US
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Telephone | 602-237-8182
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Fax |
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Provider Business Mailing Address
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Address Line | 835 W WARNER RD # 101-203
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City | GILBERT
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State | AZ
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Zip | 85233-7269
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Country | US
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Telephone | 480-202-7049
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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 | H4963
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License Number State | AZ
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