MEDICARE: DR. VATSAL SUTHAR D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	8125	SC

General Provider Information

NPI Number	:	1902141682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VATSAL SUTHAR D.M.D.

Provider Business Mailing Address
First Line	:	625 CONSTITUTION DR
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29154-8190
Country	:	US
Telephone Number	:	803-773-5413
Fax Number	:

Provider Business Practice Location Address
First Line	:	625 CONSTITUTION DR
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29154-8190
Country	:	US
Telephone Number	:	803-773-5413
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2012
Last Update Date	:	04/18/2016

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