Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 15 | AR |
NPI | 1093980740 |
---|---|
Provider Name | Dr. Suzanne Kemp Coco |
First Address | Little Rock, AR 72227-2419 |
Second Address | Little Rock, AR 72227-2419 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2008 |
Last Update Date | 20/04/2020 |