Provider Demographics
NPI:1114042488
Name:SUAREZ, INES G (DDS)
Entity Type:Individual
Prefix:DR
First Name:INES
Middle Name:G
Last Name:SUAREZ
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 1:83115 REQUA AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-4625
Mailing Address - Country:US
Mailing Address - Phone:760-775-0109
Mailing Address - Fax:760-775-0159
Practice Address - Street 1:83115 REQUA AVE STE 5
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-4625
Practice Address - Country:US
Practice Address - Phone:760-775-0109
Practice Address - Fax:760-775-0159
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA469781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice