Provider Demographics
NPI:1417976465
Name:WU, SUET M (DDS, PC)
Entity Type:Individual
Prefix:DR
First Name:SUET
Middle Name:M
Last Name:WU
Suffix:
Gender:F
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 BELL BLVD
Mailing Address - Street 2:STE 7
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2080
Mailing Address - Country:US
Mailing Address - Phone:718-281-2808
Mailing Address - Fax:718-281-2898
Practice Address - Street 1:3808 BELL BLVD
Practice Address - Street 2:STE 7
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2080
Practice Address - Country:US
Practice Address - Phone:718-281-2808
Practice Address - Fax:718-281-2898
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0495981223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02381322Medicaid