Provider Demographics
NPI:1760481436
Name:WHALEN, SUSANNE URSUALA (DMD)
Entity type:Individual
Prefix:MRS
First Name:SUSANNE
Middle Name:URSUALA
Last Name:WHALEN
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 1:4440 S US HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4409
Mailing Address - Country:US
Mailing Address - Phone:812-238-3900
Mailing Address - Fax:812-232-3076
Practice Address - Street 1:4440 S US HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4409
Practice Address - Country:US
Practice Address - Phone:812-238-3900
Practice Address - Fax:812-232-3076
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice