Provider Demographics
NPI:1801984513
Name:KALINIAN, SUSIE (DMD)
Entity type:Individual
Prefix:DR
First Name:SUSIE
Middle Name:
Last Name:KALINIAN
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 1:5178 E HUNTINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-3920
Mailing Address - Country:US
Mailing Address - Phone:559-593-1407
Mailing Address - Fax:
Practice Address - Street 1:323 E BULLARD AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5286
Practice Address - Country:US
Practice Address - Phone:559-439-9998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA548161223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry