Provider Demographics
NPI:1902915192
Name:MICKLOW, SUSAN LYNN (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LYNN
Last Name:MICKLOW
Suffix:
Gender:F
Credentials:DDS MS
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Other - Credentials:
Mailing Address - Street 1:2336 US HWY 41 SOUTH
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855
Mailing Address - Country:US
Mailing Address - Phone:906-225-4520
Mailing Address - Fax:906-225-4522
Practice Address - Street 1:2336 US HWY 41 SOUTH
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855
Practice Address - Country:US
Practice Address - Phone:906-225-4520
Practice Address - Fax:906-225-4522
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010147311223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics