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General NPI Number Information
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NPI Number | 1376157370
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Entity Type | Individual
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Provider Name | JUSTIN CLAYTON SUGGS
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Gender | Male
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Dates
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Enumeration Date | 09/07/2020
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Last Update Date | 09/19/2020
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Provider Practice Location Address
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Address Line | 3101 S WESTERN AVE
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City | MARION
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State | IN
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Zip | 46953-3966
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Country | US
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Telephone | 765-662-1022
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Fax |
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Provider Business Mailing Address
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Address Line | 1511 N TUXEDO ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46201-1475
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Country | US
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Telephone | 219-331-8099
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12013487A
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License Number State | IN
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