Provider Demographics
NPI:1376551259
Name:ROBERT A. SUE D.D.S., INC.
Entity type:Organization
Organization Name:ROBERT A. SUE D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SUE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-243-3838
Mailing Address - Street 1:SUITE 570
Mailing Address - Street 2:435 ARDEN AVENUE
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1103
Mailing Address - Country:US
Mailing Address - Phone:818-243-3838
Mailing Address - Fax:818-243-6168
Practice Address - Street 1:SUITE 570
Practice Address - Street 2:435 ARDEN AVENUE
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1103
Practice Address - Country:US
Practice Address - Phone:818-243-3838
Practice Address - Fax:818-243-6168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28096122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty