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General NPI Number Information
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NPI Number | 1912035817
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Entity Type | Individual
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Provider Name | SUZANNE PASTERNAK D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 02/21/2020
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Provider Practice Location Address
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Address Line | 4201 SAINT ANTOINE ST STE 2F
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City | DETROIT
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State | MI
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Zip | 48201-2153
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Country | US
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Telephone | 313-745-4622
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Fax |
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Provider Business Mailing Address
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Address Line | 42301 CHERRY HILL RD
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City | CANTON
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State | MI
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Zip | 48188-9801
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Country | US
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Telephone | 734-981-4040
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Fax | 734-981-2683
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 2901017941
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License Number State | MI
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