Provider Demographics
NPI:1699959361
Name:PALLUCK, SUFIA (DDS)
Entity type:Individual
Prefix:DR
First Name:SUFIA
Middle Name:
Last Name:PALLUCK
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 1:5647 HEATHER BREEZE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-0430
Mailing Address - Country:US
Mailing Address - Phone:702-767-8537
Mailing Address - Fax:702-693-6692
Practice Address - Street 1:7720 W SAHARA AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2799
Practice Address - Country:US
Practice Address - Phone:702-862-4088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5123122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist