Provider Demographics
NPI:1861644593
Name:LEUNG, MANDY SUETLING (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANDY
Middle Name:SUETLING
Last Name:LEUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 FRANKLIN ST
Mailing Address - Street 2:SUITE 511
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-2912
Mailing Address - Country:US
Mailing Address - Phone:510-893-8066
Mailing Address - Fax:
Practice Address - Street 1:1904 FRANKLIN ST
Practice Address - Street 2:SUITE 511
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2912
Practice Address - Country:US
Practice Address - Phone:510-893-8066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA573651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice