Provider Demographics
NPI:1700309291
Name:SUL, WOOJUNG (DMD)
Entity Type:Individual
Prefix:
First Name:WOOJUNG
Middle Name:
Last Name:SUL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 E CHESTNUT ST APT 2
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5718
Mailing Address - Country:US
Mailing Address - Phone:424-202-1111
Mailing Address - Fax:
Practice Address - Street 1:295 STATE ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-7036
Practice Address - Country:US
Practice Address - Phone:207-622-9210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME45821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice