Provider Demographics
NPI:1932325651
Name:SUK, DEREK (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:
Last Name:SUK
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 1:12347 KINGSRIDE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-4116
Mailing Address - Country:US
Mailing Address - Phone:713-465-4761
Mailing Address - Fax:713-465-0365
Practice Address - Street 1:12347 KINGSRIDE LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-4116
Practice Address - Country:US
Practice Address - Phone:713-465-4761
Practice Address - Fax:713-465-0365
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX194721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161602101Medicaid