Healthcare Provider Details

I. General information

NPI: 1386578334
Provider Name (Legal Business Name): TERRA DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 W 51ST ST STE 3B
NEW YORK NY
10019-6503
US

IV. Provider business mailing address

438 W 51ST ST STE 3B
NEW YORK NY
10019-6503
US

V. Phone/Fax

Practice location:
  • Phone: 212-937-1079
  • Fax: 646-435-3080
Mailing address:
  • Phone: 212-937-1079
  • Fax: 646-435-3080

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. JI YEN SUH
Title or Position: OWNER
Credential: DMD
Phone: 201-889-1070