Healthcare Provider Details

I. General information

NPI: 1982435541
Provider Name (Legal Business Name): COLIN SUZMAN, BDS, DDS, A PROFESSIONAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 BARRANCA PKWY STE 100
IRVINE CA
92604-4754
US

IV. Provider business mailing address

4330 BARRANCA PKWY STE 100
IRVINE CA
92604-4754
US

V. Phone/Fax

Practice location:
  • Phone: 949-552-6334
  • Fax: 949-417-1879
Mailing address:
  • Phone: 949-552-6334
  • Fax: 949-417-1879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. COLIN SUZMAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 949-552-6334