Provider Demographics
NPI:1710086616
Name:SUZMAN, COLIN (DDS)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:
Last Name:SUZMAN
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 1:4330 BARRANCA PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:IRVINE
Mailing Address - State:CALIFORNIA
Mailing Address - Zip Code:92604
Mailing Address - Country:ZA
Mailing Address - Phone:949-552-6334
Mailing Address - Fax:949-552-1270
Practice Address - Street 1:4330 BARRANCA PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4755
Practice Address - Country:US
Practice Address - Phone:949-552-6334
Practice Address - Fax:949-552-1270
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37371122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist