Provider Demographics
NPI:1255318754
Name:THLICK, SU-EN CHU (DMD)
Entity Type:Individual
Prefix:DR
First Name:SU-EN
Middle Name:CHU
Last Name:THLICK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12701 MARBLESTONE DR STE 260
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-8326
Mailing Address - Country:US
Mailing Address - Phone:703-670-2114
Mailing Address - Fax:703-423-0130
Practice Address - Street 1:12701 MARBLESTONE DR STE 260
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-8326
Practice Address - Country:US
Practice Address - Phone:703-670-2114
Practice Address - Fax:703-423-0130
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010087791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice