Provider Demographics
NPI:1235768995
Name:TAN, SUEJANE IV (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUEJANE
Middle Name:IV
Last Name:TAN
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 1:300 NOVA CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-5901
Mailing Address - Country:US
Mailing Address - Phone:240-491-6059
Mailing Address - Fax:
Practice Address - Street 1:13321 NEW HAMPSHIRE AVE STE 102
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-3450
Practice Address - Country:US
Practice Address - Phone:301-989-3400
Practice Address - Fax:301-989-1700
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-05
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MD221266122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program