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Individual

STEPHANIE WAN-CHUAN SU

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
D.M.D.

Contact information

Practice address
79 AVENUE U, BROOKLYN, NY 11223-3554
(718) 373-6707
Mailing address
421 W 57TH ST, APT 6F, NEW YORK, NY 10019-1763
(617) 306-4507

Taxonomy

Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
055264
NY
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
22DI02393700
NJ
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
59246
CA

Other

Enumeration date
10/09/2010
Last updated
10/09/2010
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