Healthcare Provider Details

I. General information

NPI: 1124378187
Provider Name (Legal Business Name): JAMES C SUIT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1578 N HWY 89 SUITE 1
CHINO VALLEY AZ
86323-7624
US

IV. Provider business mailing address

592 WINDSPIRIT CIR
PRESCOTT AZ
86303-6702
US

V. Phone/Fax

Practice location:
  • Phone: 928-636-6227
  • Fax: 928-636-6228
Mailing address:
  • Phone: 928-710-5499
  • Fax: 928-636-6228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD3894
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: