Healthcare Provider Details

I. General information

NPI: 1770420077
Provider Name (Legal Business Name): SUDDUTH MANAGEMENT GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S MAIN ST STE A
FOUNTAIN INN SC
29644-1909
US

IV. Provider business mailing address

101 S MAIN ST STE A
FOUNTAIN INN SC
29644-1909
US

V. Phone/Fax

Practice location:
  • Phone: 864-531-3300
  • Fax: 864-531-3375
Mailing address:
  • Phone: 864-531-3300
  • Fax: 864-531-3375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. EVAN PATRICK SUDDUTH
Title or Position: DENTIST/OWNER
Credential: DMD
Phone: 864-531-3300