Provider Demographics
NPI:1780673947
Name:SOOHOO, WILLIAM D (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:D
Last Name:SOOHOO
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 1:2 WATCH WAY
Mailing Address - Street 2:
Mailing Address - City:LLOYD HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11743-9707
Mailing Address - Country:US
Mailing Address - Phone:631-427-6232
Mailing Address - Fax:
Practice Address - Street 1:4226 162ND ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-4125
Practice Address - Country:US
Practice Address - Phone:718-359-8449
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY362081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00673501Medicaid