Healthcare Provider Details

I. General information

NPI: 1437239118
Provider Name (Legal Business Name): GARY M. SUTTLE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N 4TH ST
OKARCHE OK
73762-0796
US

IV. Provider business mailing address

501 N 4TH ST. PO BOX 796
OKARCHE OK
73762-0796
US

V. Phone/Fax

Practice location:
  • Phone: 405-263-7603
  • Fax:
Mailing address:
  • Phone: 405-263-7603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4386
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: