# SUSAN A SHEETS DDS A PROFESSIONAL DENTAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922488352
- **Authorized official:** SUSAN ANN SHEETS DDS (OWNER/PROVIDER)
- **Authorized official phone:** (310) 525-0556

## Contact information

- **Practice address:** 131 W GRAND AVE STE B2, EL SEGUNDO, CA 90245-4243
- **Practice address phone:** (310) 832-2657
- **Mailing address:** 2515 S WESTERN AVE STE 109, SAN PEDRO, CA 90732-4643
- **Mailing address phone:** (310) 832-2657
- **Mailing address fax:** (310) 832-5164

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | — |
| 1223G0001X | General Practice Dentistry | — | — | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | — |
| 1223X2210X | Orofacial Pain Dentistry | — | NULL | Yes |
| 1223X2210X | Orofacial Pain Dentistry | — | — | Yes |
| 332BC3200X | Customized Equipment (DME) | — | NULL | — |

## Other

- **Enumeration date:** 06/01/2015
- **Last updated:** 06/01/2026