Provider Demographics
NPI:1265201271
Name:YUSUKE SUZUKI D M D INC
Entity type:Organization
Organization Name:YUSUKE SUZUKI D M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YUSUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUZUKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:209-625-5728
Mailing Address - Street 1:801 S HAM LN STE L
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-7502
Mailing Address - Country:US
Mailing Address - Phone:209-334-0630
Mailing Address - Fax:
Practice Address - Street 1:801 S HAM LN STE L
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-7502
Practice Address - Country:US
Practice Address - Phone:209-334-0630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty