Provider Demographics
NPI:1457761769
Name:SUGIARTO, SUZANNE (DDS)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:SUGIARTO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1854 NUEVA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:LA HABRA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:90631-7871
Mailing Address - Country:US
Mailing Address - Phone:562-690-8122
Mailing Address - Fax:
Practice Address - Street 1:124 S ORANGE ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-1424
Practice Address - Country:US
Practice Address - Phone:714-997-5350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33383122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist