Provider Demographics
NPI:1144238049
Name:FU, SUZAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUZAN
Middle Name:
Last Name:FU
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 1:1958 VILLAGE CENTER CIRCLE
Mailing Address - Street 2:SUITE #4
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134
Mailing Address - Country:US
Mailing Address - Phone:702-914-6600
Mailing Address - Fax:702-878-6688
Practice Address - Street 1:1958 VILLAGE CENTER CIRCLE
Practice Address - Street 2:SUITE #4
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134
Practice Address - Country:US
Practice Address - Phone:702-914-6600
Practice Address - Fax:702-878-6688
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3732122300000X
CA47260122300000X
AZ5308122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist