Provider Demographics
NPI:1407804172
Name:SUH, EDWARD S (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:S
Last Name:SUH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8575 KNOTT AVE #A
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620
Mailing Address - Country:US
Mailing Address - Phone:714-761-8575
Mailing Address - Fax:714-761-8030
Practice Address - Street 1:8575 KNOTT AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620
Practice Address - Country:US
Practice Address - Phone:714-761-8575
Practice Address - Fax:714-761-8030
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA521151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice