Dr. Suthanya Srisuro, D.D.S., M.S.
Dentist, Orthodontics and Dentofacial Orthopedics in Godfrey, IL. Individual provider (NPI-1).
NPI number1982829289
StatusActive
Last updated in NPPESJul 9, 2007
Details
- NPI
- 1982829289
- Entity type
- Individual (NPI-1)
- Name
- Dr. Suthanya Srisuro
- Credential
- D.D.S., M.S.
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Apr 13, 2007
- Last updated
- Jul 9, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223X0400X | Dentist, Orthodontics and Dentofacial Orthopedics | 21000857 | IL | Yes |
Practice location
3011 Godfrey RdGodfrey, IL 62035-1808
Phone 618-466-7966
Mailing address
1616 Frontenac Woods CtSaint Louis, MO 63131-3428
Phone 314-569-2225
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
Other Orthodontics and Dentofacial Orthopedics Dentistry providers in Godfrey, IL
Checking a whole list?
Paste up to 5,000 NPIs and download status, name, taxonomy, license and address for each one. Useful for credentialing, billing and pharmacy claim checks.