MEDICARE: DR. KETAN ARUN SUKKAWALA 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	1223P0221X	Pediatric Dentistry	19635	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	19635	OTHER	TX	DENTAL LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710030077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KETAN ARUN SUKKAWALA DDS

Provider Business Mailing Address
First Line	:	1109 ROCK PRAIRIE RD
Second Line	:	STE 300
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-8651
Country	:	US
Telephone Number	:	979-694-5200
Fax Number	:	979-694-5223

Provider Business Practice Location Address
First Line	:	1103 ROCK PRAIRIE RD STE 1001
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-8344
Country	:	US
Telephone Number	:	979-694-5200
Fax Number	:	979-694-5223

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	11/16/2017

Similar Medicare Providers

1609861939 — THC HOSPICE CARE ACQUISITION, LLC
Practice Location Address:

1103 ROCK PRAIRIE RD STE 2051B
COLLEGE STATION, TX
77845-8344

Practice Phone: 979-822-5511
Practice Fax: 979-822-3709

1427033968 — SULIK SHERIDAN ROCK PRIARIE INC.
Practice Location Address:

1105 ROCK PRAIRIE RD
COLLEGE STATION, TX
77845-8344

Practice Phone: 979-694-2200
Practice Fax: 979-696-6206

1871531541 — TRADITIONS HHC ACQUISITION LLC
Practice Location Address:

1103 ROCK PRAIRIE RD STE 2051A
COLLEGE STATION, TX
77845-8344

Practice Phone: 979-822-5511
Practice Fax: 979-822-3709

1699829531 — DR. WILLIAM ESTEL PRIVETT JR. D.D.S.
Practice Location Address:

1111 ROCK PRAIRIE RD
COLLEGE STATION, TX
77845-8344

Practice Phone: 979-775-7777
Practice Fax: 979-764-5689

1396917647 — FORTRESS HEALTH & REHAB OF ROCK PRAIRIE, LLC
Practice Location Address:

1105 ROCK PRAIRIE RD
COLLEGE STATION, TX
77845-8344

Practice Phone: 979-694-2200
Practice Fax: 979-696-6206

1730342197 — SELECT OPERATIONS OF COLLEGE STATION
Practice Location Address:

1103 ROCK PRAIRIE RD
COLLEGE STATION, TX
77845-8344

Practice Phone: 888-753-6262
Practice Fax: 888-753-6262

Directions to “ DR. KETAN ARUN SUKKAWALA DDS” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.