Provider Demographics
NPI:1447486105
Name:PARK, SUYON LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:SUYON
Middle Name:LEE
Last Name:PARK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SUE
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:3460 KINGSBORO RD NE
Mailing Address - Street 2:APT 528
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-3300
Mailing Address - Country:US
Mailing Address - Phone:646-510-7564
Mailing Address - Fax:
Practice Address - Street 1:1350 SPRING ST NW
Practice Address - Street 2:STE 600
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2864
Practice Address - Country:US
Practice Address - Phone:404-389-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0138791223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry