Provider Demographics
NPI:1144542598
Name:SUZUKI, JON BYRON (DDS, PHD, MBA)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:BYRON
Last Name:SUZUKI
Suffix:
Gender:M
Credentials:DDS, PHD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3223 N BROAD ST
Mailing Address - Street 2:336
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-5007
Mailing Address - Country:US
Mailing Address - Phone:215-707-7667
Mailing Address - Fax:215-707-0042
Practice Address - Street 1:3223 N BROAD ST
Practice Address - Street 2:336
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5007
Practice Address - Country:US
Practice Address - Phone:215-707-7667
Practice Address - Fax:215-707-0042
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023235L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics