Individual
DR. LAURIE SUSARCHICK-STACHE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS MS
Contact information
Practice address
1435 W WALTON ST UNIT 2, CHICAGO, IL 60642-5311
(551) 486-1883
Mailing address
1435 W WALTON ST UNIT 2, CHICAGO, IL 60642-5311
(551) 486-1883
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
019032057
IL
Other
Enumeration date
01/30/2021
Last updated
01/30/2021
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