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General NPI Number Information
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NPI Number | 1558579433
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Entity Type | Individual
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Provider Name | SUZANNE M WILBUR D.M.D,P.A.
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Gender | Female
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 12/30/2015
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Provider Practice Location Address
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Address Line | 800 ZEAGLER DR STE 420
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City | PALATKA
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State | FL
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Zip | 32177-3883
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Country | US
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Telephone | 386-325-7131
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Fax | 386-325-7123
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Provider Business Mailing Address
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Address Line | 800 ZEAGLER DR 420
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City | PALATKA
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State | FL
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Zip | 32177-3867
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Country | US
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Telephone | 386-325-7131
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Fax | 386-325-7123
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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 | DN0014966
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License Number State | FL
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