Provider Demographics
NPI:1518338706
Name:SUZUKI, TAKAHIRO (DDS)
Entity Type:Individual
Prefix:
First Name:TAKAHIRO
Middle Name:
Last Name:SUZUKI
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 1:2120 HEDGCOXE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-3145
Mailing Address - Country:US
Mailing Address - Phone:469-814-8211
Mailing Address - Fax:
Practice Address - Street 1:2120 HEDGCOXE RD STE 150
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-3145
Practice Address - Country:US
Practice Address - Phone:469-814-8211
Practice Address - Fax:469-814-8028
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice