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General NPI Number Information
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NPI Number | 1679006936
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Entity Type | Organization
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Legal Business Name | DR ALBIN SUSEK
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Dates
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Enumeration Date | 04/04/2017
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Last Update Date | 04/04/2017
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Provider Practice Location Address
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Address Line | 824 E MAIN ST
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City | NANTICOKE
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State | PA
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Zip | 18634-1832
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Country | US
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Telephone | 570-735-4005
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Fax | 570-735-4005
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Provider Business Mailing Address
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Address Line | 824 E MAIN ST
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City | NANTICOKE
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State | PA
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Zip | 18634-1832
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Country | US
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Telephone | 570-735-4005
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Fax | 570-735-4005
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ALBIN F SUSEK
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Credential | DDS
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Telephone | 570-735-4005
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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 | DS019274L
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License Number State | PA
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