Provider Demographics
NPI:1730193517
Name:SHEETS, SUSAN ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ANN
Last Name:SHEETS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 S WESTERN AVE
Mailing Address - Street 2:109
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-4643
Mailing Address - Country:US
Mailing Address - Phone:310-832-2657
Mailing Address - Fax:310-832-5164
Practice Address - Street 1:2515 S WESTERN AVE
Practice Address - Street 2:109
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-4643
Practice Address - Country:US
Practice Address - Phone:310-832-2657
Practice Address - Fax:310-832-5164
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA361961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice