Provider Demographics
NPI:1780251660
Name:HSU, SALLY (DDS)
Entity type:Individual
Prefix:DR
First Name:SALLY
Middle Name:
Last Name:HSU
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 1:1420 BLUE OAKS BLVD STE 180
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-7359
Mailing Address - Country:US
Mailing Address - Phone:916-893-8438
Mailing Address - Fax:
Practice Address - Street 1:1420 BLUE OAKS BLVD STE 180
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-7359
Practice Address - Country:US
Practice Address - Phone:916-780-9688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45469122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist