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Individual

SUSAN PARK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
DDS

Contact information

Practice address
709 N MAIN ST, NORTH SYRACUSE, NY 13212-1669
(315) 452-5915
Mailing address
3850 N CAUSEWAY BLVD, SUITE 800, METAIRIE, LA 70002-1752
(800) 622-7645

Taxonomy

Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
048609-1
NY

Other

Enumeration date
01/09/2007
Last updated
08/24/2010
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