Provider Demographics
NPI:1760836936
Name:SUWWAN, LEILA EL-YOUSSEF (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEILA
Middle Name:EL-YOUSSEF
Last Name:SUWWAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 BEACON ST STE 353
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-3202
Mailing Address - Country:US
Mailing Address - Phone:617-734-6300
Mailing Address - Fax:
Practice Address - Street 1:1330 BEACON ST STE 353
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3202
Practice Address - Country:US
Practice Address - Phone:617-734-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2017-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18572101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice