Provider Demographics
NPI:1487718417
Name:MASRI, SUZAN M (DDS)
Entity type:Individual
Prefix:DR
First Name:SUZAN
Middle Name:M
Last Name:MASRI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N SANTA ANITA AVE
Mailing Address - Street 2:SUITE 820
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3113
Mailing Address - Country:US
Mailing Address - Phone:626-445-1117
Mailing Address - Fax:626-445-1161
Practice Address - Street 1:150 N SANTA ANITA AVE
Practice Address - Street 2:SUITE 820
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3113
Practice Address - Country:US
Practice Address - Phone:626-445-1117
Practice Address - Fax:626-445-1161
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA445101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93629-01Medicare ID - Type UnspecifiedDENTICAL