Provider Demographics
NPI:1538258389
Name:SULUKI, MARYAM M (DMD)
Entity type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:M
Last Name:SULUKI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 SUNSET RD
Mailing Address - Street 2:STE 308
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-1108
Mailing Address - Country:US
Mailing Address - Phone:609-835-4043
Mailing Address - Fax:609-835-1576
Practice Address - Street 1:215 SUNSET RD
Practice Address - Street 2:STE 308
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-1108
Practice Address - Country:US
Practice Address - Phone:609-835-4043
Practice Address - Fax:609-835-1576
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ 126631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ51680OtherID UNITED CONCORDIA