Provider Demographics
NPI:1558403386
Name:SUCHAK, ATUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ATUL
Middle Name:
Last Name:SUCHAK
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 1:910 S SUNSET AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3409
Mailing Address - Country:US
Mailing Address - Phone:626-337-6166
Mailing Address - Fax:626-337-1176
Practice Address - Street 1:910 S SUNSET AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3409
Practice Address - Country:US
Practice Address - Phone:626-337-6166
Practice Address - Fax:626-337-1176
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA360091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB36009-02OtherDENTICAL