MEDICARE: DR. CHARLES MICHAEL SAUTER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	15824	TX

General Provider Information

NPI Number	:	1003811308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES MICHAEL SAUTER DDS

Provider Business Mailing Address
First Line	:	1425 GROSS RD
Second Line	:	STE 116
City	:	MESQUITE
State	:	TX
Zip	:	75149-1365
Country	:	US
Telephone Number	:	972-289-3139
Fax Number	:

Provider Business Practice Location Address
First Line	:	1425 GROSS RD
Second Line	:	STE 116
City	:	MESQUITE
State	:	TX
Zip	:	75149-1365
Country	:	US
Telephone Number	:	972-289-3139
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	07/09/2007

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