Provider Demographics
NPI:1881941300
Name:SU, LEON YU LIANG (DDS)
Entity type:Individual
Prefix:DR
First Name:LEON
Middle Name:YU LIANG
Last Name:SU
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 1:633 CENTRAL AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029-1216
Mailing Address - Country:US
Mailing Address - Phone:714-510-1737
Mailing Address - Fax:
Practice Address - Street 1:633 CENTRAL AVE APT 2
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NJ
Practice Address - Zip Code:07029-1216
Practice Address - Country:US
Practice Address - Phone:714-510-1737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI251231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice