Provider Demographics
NPI:1356743066
Name:SUK, TONY (DDS)
Entity type:Individual
Prefix:DR
First Name:TONY
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 1:1771 OCEANSIDE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-3478
Mailing Address - Country:US
Mailing Address - Phone:760-433-6081
Mailing Address - Fax:760-433-8715
Practice Address - Street 1:1771 OCEANSIDE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-3478
Practice Address - Country:US
Practice Address - Phone:760-433-6081
Practice Address - Fax:760-433-8715
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA498071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice