Provider Demographics
NPI:1124234752
Name:SUH, PETER SUKMAN (DMD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:SUKMAN
Last Name:SUH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1346 FOOTHILL BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:LA CANADA FLINTRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91011
Mailing Address - Country:US
Mailing Address - Phone:818-790-5959
Mailing Address - Fax:818-790-6399
Practice Address - Street 1:1346 FOOTHILL BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:LA CANADA FLINTRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91011
Practice Address - Country:US
Practice Address - Phone:818-790-5959
Practice Address - Fax:818-790-6399
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 424251223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry