Individual
SUSAN MARIE COCQUYT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
734 E IRELAND RD, SOUTH BEND, IN 46614-2662
(574) 299-9300
Mailing address
734 E IRELAND RD, SOUTH BEND, IN 46614-2662
(574) 299-9300
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12009553
IN
Other
Enumeration date
12/04/2006
Last updated
07/08/2007
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