Individual
CHARLES SU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
7275 E SOUTHGATE DR, 205, SACRAMENTO, CA 95823-2628
(916) 399-1318
Mailing address
7275 E SOUTHGATE DR, 205, SACRAMENTO, CA 95823-2628
(916) 399-1318
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
42096
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
B42096
—
CA
Enumeration date
09/21/2006
Last updated
07/08/2007
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