Provider Demographics
NPI:1053427856
Name:KWEE, SUSAN T (DDS)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:T
Last Name:KWEE
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 1:1028 WASHINGTON AVE S
Mailing Address - Street 2:
Mailing Address - City:OLD TAPPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-7233
Mailing Address - Country:US
Mailing Address - Phone:201-666-9552
Mailing Address - Fax:
Practice Address - Street 1:1028 WASHINGTON AVE S
Practice Address - Street 2:
Practice Address - City:OLD TAPPAN
Practice Address - State:NJ
Practice Address - Zip Code:07675-7233
Practice Address - Country:US
Practice Address - Phone:201-666-9552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01598600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist