Organization
MAT-SU PLASTIC SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN J DEAN MD (OWNER)
(704) 859-6261
Entity
Organization
Contact information
Practice address
2490 S WOODWORTH LOOP, SUITE 310, PALMER, AK 99645-7405
(907) 746-6100
Mailing address
2490 S WOODWORTH LOOP, SUITE 310, PALMER, AK 99645-7405
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
6242
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8928018
—
NC
Enumeration date
10/11/2011
Last updated
10/11/2011
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