Susan E Vickers DMD PA

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Legal business name

SUSAN E VICKERS DMD PA

Practice address

11029 Racetrack Rd
Berlin, MD 21811

Phone

(410) 749-0009

Fax

(410) 749-0022

NPI assigned

Mar 13, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Susan E Vickers, DMD MS

Title

Owner President

Phone

(410) 749-0009

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1114050820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1730",
            "city": "BERLIN",
            "state": "MD",
            "postal_code": "21811",
            "telephone_number": "410-749-0009",
            "fax_number": "410-749-0022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11029 RACETRACK RD",
            "city": "BERLIN",
            "state": "MD",
            "postal_code": "21811",
            "telephone_number": "410-749-0009",
            "fax_number": "410-749-0022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSAN E VICKERS DMD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "VICKERS",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "410-749-0009",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD MS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000039987",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Monica Stone, LCPC
• Emma Elizabeth Sturgis-Fortt, LPN
• Erin Kathleen Sullivan
• Kelly Sullivan
• Molly Sullivan, DPT
• Scott Sweeney, DO
• Maryjane Szimanski
• Christopher West Tabb III, LCPC
• Samantha Paulette Tatem
• Lisa A. Taylor

• Orthodontics and Dentofacial Orthopedics Dentistry in Berlin, MD
• Providers in Berlin, MD by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.