Provider Demographics
NPI:1992863948
Name:TULENKO, SUZANNE B (DMD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:B
Last Name:TULENKO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 F ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2801
Mailing Address - Country:US
Mailing Address - Phone:619-585-1995
Mailing Address - Fax:619-585-1997
Practice Address - Street 1:235 F ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2801
Practice Address - Country:US
Practice Address - Phone:619-585-1995
Practice Address - Fax:619-585-1997
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA394941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice