Healthcare Provider Details

I. General information

NPI: 1699787333
Provider Name (Legal Business Name): GARY R SUGG DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 PARK ROAD STE B104
CHARLOTTE NC
28209-3723
US

IV. Provider business mailing address

4525 PARK ROAD STE B104
CHARLOTTE NC
28209-3723
US

V. Phone/Fax

Practice location:
  • Phone: 704-527-4895
  • Fax: 704-527-1407
Mailing address:
  • Phone: 704-527-4895
  • Fax: 704-527-1407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number120
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: