Provider Demographics
NPI:1932260528
Name:SUEKAWA, TODD S (DDS)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:S
Last Name:SUEKAWA
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 1:2178 S 900 E SUITE 5
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2388
Mailing Address - Country:US
Mailing Address - Phone:801-487-4606
Mailing Address - Fax:801-487-6198
Practice Address - Street 1:2178 S 900 E SUITE 5
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84106-2388
Practice Address - Country:US
Practice Address - Phone:801-487-4606
Practice Address - Fax:801-487-6198
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT953123229921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist