Provider Demographics
NPI:1134696594
Name:SUH, ELIOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIOTT
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 1:908 CALTHROP NECK RD
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-2222
Mailing Address - Country:US
Mailing Address - Phone:704-968-2422
Mailing Address - Fax:
Practice Address - Street 1:1070 W MERCURY BLVD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3378
Practice Address - Country:US
Practice Address - Phone:757-637-4203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2023-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD1205122300000X
VA04014184131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist