Provider Demographics
NPI:1609901925
Name:SU, MENG (DMD)
Entity Type:Individual
Prefix:
First Name:MENG
Middle Name:
Last Name:SU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9950 JONES BRIDGE RD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022
Mailing Address - Country:US
Mailing Address - Phone:678-366-1000
Mailing Address - Fax:678-366-1111
Practice Address - Street 1:9950 JONES BRIDGE RD
Practice Address - Street 2:SUITE 700
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022
Practice Address - Country:US
Practice Address - Phone:678-366-1000
Practice Address - Fax:678-366-1111
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11969122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist