Susan E St George, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401412498 Issued in VA

Practice address

23 Goodrich Ave
Petersburg, VA 23805-2119

Phone

(804) 861-5237

Fax

(804) 861-1601

NPI assigned

Aug 10, 2010

Last updated

Mar 15, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Petersburg Complete Dental Care PLLC

  • General Practice Dentistry
  • Petersburg, VA
  • NPI 1770824435
  NPD (past) Authorized official
• Dr Cathie H Butterworth

  dba Fredericksburg Smile Center

  • General Practice Dentistry
  • Fredericksburg, VA
  • NPI 1063614576
  NPD (past)
• SC - Fredericksburg PLLC

  • General Practice Dentistry
  • Fredericksburg, VA
  • NPI 1467316513
  NPD (past)

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

{
    "created_epoch": "1281398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710460800000",
    "number": "1720393168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 GOODRICH AVE",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238052119",
            "telephone_number": "804-861-5237",
            "fax_number": "804-861-1601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 GOODRICH AVE",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238052119",
            "telephone_number": "804-861-5237",
            "fax_number": "804-861-1601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ST GEORGE",
        "first_name": "SUSAN",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-10",
        "last_updated": "2024-03-15",
        "certification_date": "2024-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401412498",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Specialized Youth Services of VA, Inc
• Heather N. Spivey, MSW, LCSW, CSAC
• Spring Oak Assisted Living at Petersburg
• Spring of Hope Therapeutic Services, LLC
• Edde Karen Springer, CRNA
• Lawrence Carlton Starke II, L.P.C.
• Robin S Starke
• Starkewood Christian Counseling Services, P.C.
• Evan Stewart
• Terrelle N Stewart, LPC

• General Practice Dentistry in Petersburg, VA
• Providers in Petersburg, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.