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General NPI Number Information
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NPI Number | 1548415771
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Entity Type | Individual
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Provider Name | SUSAN F. WILBORN-HOOD DDS
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Gender | Female
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Dates
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Enumeration Date | 12/02/2008
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 436 TIORAM LN SE
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City | SMYRNA
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State | GA
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Zip | 30082-5239
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Country | US
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Telephone | 708-825-4571
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Fax | 708-825-4571
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Provider Business Mailing Address
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Address Line | 3330 PIEDMONT RD.
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City | ATLANTA
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State | GA
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Zip | 30305
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Country | US
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Telephone | 404-237-5330
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN015339
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019-019945
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License Number State | IL
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