Provider Demographics
NPI:1700222171
Name:ATUL SUCHAK DDS DENTAL CORPORATION
Entity Type:Organization
Organization Name:ATUL SUCHAK DDS DENTAL CORPORATION
Other - Org Name:QUEENS DENTAL GOUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ATUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SUCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-337-6166
Mailing Address - Street 1:910 S SUNSET AVE
Mailing Address - Street 2:SUITE 4
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 4
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36009122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty