Provider Demographics
NPI:1477737260
Name:LEE, SUZANNA NGOC (DDS,MAGD)
Entity Type:Individual
Prefix:MS
First Name:SUZANNA
Middle Name:NGOC
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS,MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 N SHORELINE BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-3106
Mailing Address - Country:US
Mailing Address - Phone:650-988-9998
Mailing Address - Fax:650-988-7095
Practice Address - Street 1:570 N SHORELINE BLVD STE G
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-3106
Practice Address - Country:US
Practice Address - Phone:650-988-9998
Practice Address - Fax:650-988-7095
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA244728122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist