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NPI Code Detail

MEDICARE: JILL A SUSALLA

MEDICARE: JILL A SUSALLA
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
1124Q00000XDental Hygienist290200403MI

General Provider Information

NPI Number : 1235638586
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL A SUSALLA
Provider Business Mailing Address
First Line : 8326 N SAGINAW RD
Second Line :
City : MOUNT MORRIS
State : MI
Zip : 48458-1648
Country : US
Telephone Number : 810-687-5040
Fax Number : 810-687-5130
Provider Business Practice Location Address
First Line : 8326 N SAGINAW RD
Second Line :
City : MOUNT MORRIS
State : MI
Zip : 48458-1648
Country : US
Telephone Number : 810-687-5040
Fax Number : 810-687-5130
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2018
Last Update Date : 02/01/2018

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Directions to “ JILL A SUSALLA ” Practice Location

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