Individual
DR. SUSAN BON TIEDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
2151
MT
1223P0221X
Pediatric Dentistry
5820
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0113191
—
MT
01
—
1942483524
OFFICE NATIONAL PROVIDER IDENTIFIER
MT
Enumeration date
06/01/2006
Last updated
10/05/2023
Update your record
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