Provider Demographics
NPI:1003284969
Name:SUH, EUNJIN M (DDS)
Entity Type:Individual
Prefix:MISS
First Name:EUNJIN
Middle Name:M
Last Name:SUH
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 1:500 N TARRANT PKWY APT 122
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-5677
Mailing Address - Country:US
Mailing Address - Phone:512-788-3705
Mailing Address - Fax:
Practice Address - Street 1:5416 BASSWOOD BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-4400
Practice Address - Country:US
Practice Address - Phone:817-656-1215
Practice Address - Fax:877-230-8349
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD309561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice