Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 15800 | TX |
NPI | 1144560400 |
---|---|
Provider Name | Dr. Susan Karlene Hummel |
First Address | Dallas, TX 75244-4423 |
Second Address | Dallas, TX 75244-4423 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2013 |
Last Update Date | 25/02/2013 |