Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 50378 | CA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | DEN.00202935 | CO |
Y | 204E00000X | Oral & Maxillofacial Surgeon | DR.0057245 | CO |
N | 204E00000X | Oral & Maxillofacial Surgeon | ME110177 | FL |
NPI | 1205164878 |
---|---|
Provider Name | Terry Su |
First Address | Aurora, CO 80045-2532 |
Second Address | Aurora, CO 80045-2532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2009 |
Last Update Date | 31/01/2022 |