Provider Demographics
NPI:1922329580
Name:WEBB, SUFFIYAH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUFFIYAH
Middle Name:
Last Name:WEBB
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 1:168 RTE 10 W
Mailing Address - Street 2:
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876
Mailing Address - Country:US
Mailing Address - Phone:973-584-7555
Mailing Address - Fax:
Practice Address - Street 1:115 POMONA AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2214
Practice Address - Country:US
Practice Address - Phone:973-926-2518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DIO24414001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice