Provider Demographics
NPI:1689833865
Name:SUZUKI, YUSUKE (DMD)
Entity Type:Individual
Prefix:DR
First Name:YUSUKE
Middle Name:
Last Name:SUZUKI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S HAM LN
Mailing Address - Street 2:SUITE L
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-7501
Mailing Address - Country:US
Mailing Address - Phone:707-315-1541
Mailing Address - Fax:
Practice Address - Street 1:211 CADLONI LN
Practice Address - Street 2:B
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-8623
Practice Address - Country:US
Practice Address - Phone:707-315-1541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA503791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice