Provider Demographics
NPI:1134204191
Name:SU, STEPHANIE M (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:M
Last Name:SU
Suffix:
Gender:F
Credentials:DDS
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Mailing Address - Street 1:16650 NE 79TH ST
Mailing Address - Street 2:#100
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4442
Mailing Address - Country:US
Mailing Address - Phone:425-558-4562
Mailing Address - Fax:425-558-4572
Practice Address - Street 1:16650 NE 79TH ST
Practice Address - Street 2:#100
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4442
Practice Address - Country:US
Practice Address - Phone:425-558-4562
Practice Address - Fax:425-558-4572
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WADE000098111223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry