Provider Demographics
NPI:1235231150
Name:SU, ESTHER
Entity Type:Individual
Prefix:MRS
First Name:ESTHER
Middle Name:
Last Name:SU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7305 BALTIMORE AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-3234
Mailing Address - Country:US
Mailing Address - Phone:301-927-2500
Mailing Address - Fax:301-927-2555
Practice Address - Street 1:7305 BALTIMORE AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-3234
Practice Address - Country:US
Practice Address - Phone:301-927-2500
Practice Address - Fax:301-927-2555
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12485122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist