Provider Demographics
NPI:1720107386
Name:SUKUT, ALBERT EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:EDWARD
Last Name:SUKUT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 BRISTOL ST
Mailing Address - Street 2:C102
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5981
Mailing Address - Country:US
Mailing Address - Phone:714-540-6852
Mailing Address - Fax:714-540-8066
Practice Address - Street 1:2900 BRISTOL ST
Practice Address - Street 2:C102
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5981
Practice Address - Country:US
Practice Address - Phone:714-540-6852
Practice Address - Fax:714-540-8066
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA232701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice