Individual provider · Type 1 NPI
Suthanya Srisuro, DDS, M.S.
Orthodontics and Dentofacial Orthopedics Dentistry · Godfrey, IL
Practice location
3011 Godfrey Rd
Godfrey, IL 62035-1808
Mailing address
1616 Frontenac Woods Ct
St. Louis, MO 63131-3428
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry Primary | 1223X0400X | 21000857 (IL) |
Orthodontics and Dentofacial Orthopedics Dentistry: That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of funct…
Another provider at this address
About NPI 1982829289
Suthanya Srisuro, DDS, M.S.'s National Provider Identifier is 1982829289, issued on Apr 13, 2007. The primary taxonomy on file is Orthodontics and Dentofacial Orthopedics Dentistry (1223X0400X), and the practice location is in Godfrey, IL. The record was last updated on Jul 9, 2007.