MEDICARE: M. SUZANNE AHNQUIST, D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1114128410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M. SUZANNE AHNQUIST, D.M.D.

Provider Business Mailing Address
First Line	:	1508 OXFORD DR
Second Line	:
City	:	GEORGETOWN
State	:	KY
Zip	:	40324-9266
Country	:	US
Telephone Number	:	502-863-0880
Fax Number	:	502-867-7363

Provider Business Practice Location Address
First Line	:	1508 OXFORD DR
Second Line	:
City	:	GEORGETOWN
State	:	KY
Zip	:	40324-9266
Country	:	US
Telephone Number	:	502-863-0880
Fax Number	:	502-867-7363

Authorized Official
Title or Position	:	DOCTOR-OWNER
Name	:	DR. MARY SUZANNE AHNQUIST
Credential	:	DMD
Telephone Number	:	502-863-0880

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	08/22/2020

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