Provider Demographics
NPI:1104057983
Name:SU, JESSICA YEN-PING (DMD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:YEN-PING
Last Name:SU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9180 BELLAIRE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-4600
Mailing Address - Country:US
Mailing Address - Phone:713-773-1300
Mailing Address - Fax:713-773-3311
Practice Address - Street 1:9180 BELLAIRE BLVD STE B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-4600
Practice Address - Country:US
Practice Address - Phone:713-773-1300
Practice Address - Fax:713-773-3311
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX274361223D0004X, 1223G0001X
CA584941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223D0004XDental ProvidersDentistDental Anesthesiology