Provider Demographics
NPI:1639238702
Name:SUJAN, BINA C (DDS)
Entity Type:Individual
Prefix:
First Name:BINA
Middle Name:C
Last Name:SUJAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5464 SOUTH STREET
Mailing Address - Street 2:LAKEWOOD DENTAL CENTER
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712
Mailing Address - Country:US
Mailing Address - Phone:562-866-0705
Mailing Address - Fax:
Practice Address - Street 1:5464 SOUTH STREET
Practice Address - Street 2:LAKEWOOD DENTAL CENTER
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712
Practice Address - Country:US
Practice Address - Phone:562-866-0705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26707122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist