Wijaya Sulaeman, D.D.S.
LBN: Sulaeman Professional Dental, Inc.
Wijaya Sulaeman, D.D.S. is an health care organization with primary practice located at 25054 Base Line St , San Bernardino CA 92410-4026. The organization recently has only one registered license in Dental Providers / General Practice, which is considered as the primary health care specialty.
Sulaeman Professional Dental, Inc. can be contacted via phone (909) 889-9591, or through Sulaeman, Audrey Indhira via phone (909) 889-9591.
Contact Information
Primary practice address
25054 Base Line St
San Bernardino CA 92410-4026
Phone: (909) 889-9591
Fax: (909) 889-8721
Website:
Authorized official contact:
Name: Sulaeman, Audrey Indhira Doctor of Dental Surgery (DDS)
Phone: (909) 889-9591
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 37166 | California |
Profile Details
| NPI number | 1063537538 |
|---|---|
| LBN Legal business name | Sulaeman Professional Dental, Inc. |
| DBA Doing business as | Wijaya Sulaeman, D.D.S. |
| Authorized official | Sulaeman, Audrey Indhira Doctor of Dental Surgery (DDS) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Mar 21st, 2007 |
| Last updated | Aug 22nd, 2020 - about 4 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1063537538 | NPPES |
| California | MEDICAID | D37166 | |
| California | MEDICAID | D44254 | |
| California | MEDICAID | D48030 |
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