Healthcare Provider Details

I. General information

NPI: 1710086616
Provider Name (Legal Business Name): COLIN SUZMAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 BARRANCA PKWY SUITE 100
IRVINE CA
92604-4755
US

IV. Provider business mailing address

4330 BARRANCA PKWY SUITE 100
IRVINE CALIFORNIA
92604
ZA

V. Phone/Fax

Practice location:
  • Phone: 949-552-6334
  • Fax: 949-552-1270
Mailing address:
  • Phone: 949-552-6334
  • Fax: 949-552-1270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number37371
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: