Healthcare Provider Details

I. General information

NPI: 1750785887
Provider Name (Legal Business Name): SUSAN HUH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3808 BELL BLVD STE 3
BAYSIDE NY
11361-2080
US

IV. Provider business mailing address

2 LAKEVIEW DR
GREAT NECK NY
11020-1618
US

V. Phone/Fax

Practice location:
  • Phone: 718-578-7550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number046886
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: