Provider Demographics
NPI:1417927195
Name:SUANICO, DEAN (DDS)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:SUANICO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7614 N FRESNO ST
Mailing Address - Street 2:#101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-7405
Mailing Address - Country:US
Mailing Address - Phone:559-431-6400
Mailing Address - Fax:559-431-6440
Practice Address - Street 1:7614 N FRESNO ST
Practice Address - Street 2:#101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-7405
Practice Address - Country:US
Practice Address - Phone:559-431-6400
Practice Address - Fax:559-431-6440
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA521761223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics