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NPI Code Detail

MEDICARE: SUTTER DENTAL PC

MEDICARE: SUTTER DENTAL PC
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
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1518033935
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUTTER DENTAL PC
Provider Business Mailing Address
First Line : 26 WYCHWOOD LN
Second Line :
City : SOUTH BARRINGTON
State : IL
Zip : 60010-6122
Country : US
Telephone Number : 847-722-7615
Fax Number :
Provider Business Practice Location Address
First Line : 7728 W NORTH AVE
Second Line :
City : ELMWOOD PARK
State : IL
Zip : 60707-4124
Country : US
Telephone Number : 773-745-8300
Fax Number :
Authorized Official
Title or Position : OWNER DENTIST
Name : DR. VESNA S SUTTER
Credential : DDS
Telephone Number : 847-722-7615
Provider Enumeration Date : 11/28/2006
Last Update Date : 12/16/2020

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