Provider Demographics
NPI:1619359726
Name:SULJIC, ORHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ORHAN
Middle Name:
Last Name:SULJIC
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 1:4213 62ND ST
Mailing Address - Street 2:APT. #5
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-2856
Mailing Address - Country:US
Mailing Address - Phone:515-822-5095
Mailing Address - Fax:
Practice Address - Street 1:4919 DOUGLAS AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-2775
Practice Address - Country:US
Practice Address - Phone:515-278-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-092051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice