Individual
DR. JACK SU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1950 SHERIDAN DR., 5E, BUFFALO, NY 14223-1240
(716) 875-3660
Mailing address
1950 SHERIDAN DR., 5E, BUFFALO, NY 14223-1240
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
049306
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02164125
—
NY
Enumeration date
10/04/2006
Last updated
07/08/2007
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