Provider Demographics
NPI:1003441890
Name:SUH, ETHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:
Last Name:SUH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24151 BELLA DOLCE LN APT 609
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7906
Mailing Address - Country:US
Mailing Address - Phone:214-790-4691
Mailing Address - Fax:
Practice Address - Street 1:430 MEYER ST
Practice Address - Street 2:
Practice Address - City:SEALY
Practice Address - State:TX
Practice Address - Zip Code:77474-2744
Practice Address - Country:US
Practice Address - Phone:979-399-8267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX357741223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice