Provider Demographics
NPI:1447550686
Name:IZZO, SUSAN J (BSDH)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:IZZO
Suffix:
Gender:F
Credentials:BSDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 S PERKASIE RD
Mailing Address - Street 2:
Mailing Address - City:PERKASIE
Mailing Address - State:PA
Mailing Address - Zip Code:18944-2454
Mailing Address - Country:US
Mailing Address - Phone:215-258-5155
Mailing Address - Fax:
Practice Address - Street 1:212 S PERKASIE RD
Practice Address - Street 2:
Practice Address - City:PERKASIE
Practice Address - State:PA
Practice Address - Zip Code:18944-2454
Practice Address - Country:US
Practice Address - Phone:215-258-5155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH-005665L124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist