Provider Demographics
NPI:1700897733
Name:NGUYEN-SU, SUZIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUZIE
Middle Name:
Last Name:NGUYEN-SU
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 1:2451 PROFESSIONAL COURT
Mailing Address - Street 2:#110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128
Mailing Address - Country:US
Mailing Address - Phone:702-240-4242
Mailing Address - Fax:702-240-6545
Practice Address - Street 1:2451 PROFESSIONAL COURT
Practice Address - Street 2:STE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128
Practice Address - Country:US
Practice Address - Phone:702-240-4242
Practice Address - Fax:702-240-6545
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV30771223G0001X
CA418581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice