Provider Demographics
NPI:1649620535
Name:SUY, SALINA SOPHERA (DDS)
Entity type:Individual
Prefix:
First Name:SALINA
Middle Name:SOPHERA
Last Name:SUY
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 1:1606 GENESEE ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5431
Mailing Address - Country:US
Mailing Address - Phone:716-308-1891
Mailing Address - Fax:
Practice Address - Street 1:8 BUSINESS PARK CT
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-6308
Practice Address - Country:US
Practice Address - Phone:315-732-6719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0591291223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program