Provider Demographics
NPI:1285922385
Name:SUET WU DDS PC
Entity type:Organization
Organization Name:SUET WU DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUET
Authorized Official - Middle Name:M
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-281-2808
Mailing Address - Street 1:3808 BELL BLVD
Mailing Address - Street 2:STE 7
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2080
Mailing Address - Country:US
Mailing Address - Phone:718-281-2808
Mailing Address - Fax:718-281-2898
Practice Address - Street 1:3808 BELL BLVD
Practice Address - Street 2:STE 7
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2080
Practice Address - Country:US
Practice Address - Phone:718-281-2808
Practice Address - Fax:718-281-2898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0495981223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02381322Medicaid