Provider Demographics
NPI:1043830409
Name:MAMO, SUZANA (DMD)
Entity type:Individual
Prefix:
First Name:SUZANA
Middle Name:
Last Name:MAMO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CRESSKILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07626-2543
Mailing Address - Country:US
Mailing Address - Phone:201-707-2511
Mailing Address - Fax:
Practice Address - Street 1:846 BERGEN AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4404
Practice Address - Country:US
Practice Address - Phone:201-965-3189
Practice Address - Fax:201-946-1641
Is Sole Proprietor?:No
Enumeration Date:2020-04-25
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI028347001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice