Provider Demographics
NPI:1801006747
Name:MARYAM M SULUKI DMD & ASSOCIATES
Entity Type:Organization
Organization Name:MARYAM M SULUKI DMD & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:SULUKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-835-4043
Mailing Address - Street 1:215 SUNSET RD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-1108
Mailing Address - Country:US
Mailing Address - Phone:609-883-5404
Mailing Address - Fax:609-835-1576
Practice Address - Street 1:215 SUNSET RD
Practice Address - Street 2:SUITE 308
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-1108
Practice Address - Country:US
Practice Address - Phone:609-883-5404
Practice Address - Fax:609-835-1576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D101266300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty