Healthcare Provider Details

I. General information

NPI: 1093142929
Provider Name (Legal Business Name): EDWARD G. SUTTER DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2013
Last Update Date: 10/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1422 SENECA ST
SEATTLE WA
98101-2830
US

IV. Provider business mailing address

1422 SENECA ST
SEATTLE WA
98101-2830
US

V. Phone/Fax

Practice location:
  • Phone: 206-323-7659
  • Fax: 206-323-4668
Mailing address:
  • Phone: 206-323-7659
  • Fax: 206-323-4668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberD160274140
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE8997
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE2853
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDE4402
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH60180349
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH1320
License Number StateWA
# 7
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberD160028280
License Number StateWA
# 8
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberD160029707
License Number StateWA
# 9
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberD160030003
License Number StateWA
# 10
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE2891
License Number StateWA

VIII. Authorized Official

Name: DR. EDWARD GEORGE SUTTER SR.
Title or Position: OWNER
Credential: DDS
Phone: 206-323-7659