Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DS023235L | PA |
NPI | 1144542598 |
---|---|
Provider Name | Dr. Jon Byron Suzuki |
First Address | Philadelphia, PA 19140-5007 |
Second Address | Philadelphia, PA 19140-5007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2010 |
Last Update Date | 25/02/2010 |