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Individual

DR. CHAD BRICKER SUSOTT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.D.S

Contact information

Practice address
325 E H ST, DENTAL CLINIC, IRON MOUNTAIN, MI 49801-4760
(906) 774-3300
Mailing address
702 HILLCREST DR, IRON MOUNTAIN, MI 49801-6644
(906) 774-4814

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901020759
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2901020759
MICHIGAN DENTAL LICENCE
MI
Enumeration date
08/16/2012
Last updated
08/16/2012
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