Provider Demographics
NPI:1053404319
Name:WITT-TRABUCHI, SUSAN A (DDS)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:A
Last Name:WITT-TRABUCHI
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 1:91 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-4844
Mailing Address - Country:US
Mailing Address - Phone:856-691-9400
Mailing Address - Fax:856-691-6282
Practice Address - Street 1:91 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-4844
Practice Address - Country:US
Practice Address - Phone:856-691-9400
Practice Address - Fax:856-691-6282
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI013259001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice