MEDICARE: DR. EDWARD GEORGE SUTTER SR. 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	2891	WA

General Provider Information

NPI Number	:	1730120734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD GEORGE SUTTER SR. DDS

Provider Business Mailing Address
First Line	:	1422 SENECA ST
Second Line	:	SUITE 311
City	:	SEATTLE
State	:	WA
Zip	:	98101-2830
Country	:	US
Telephone Number	:	206-323-7659
Fax Number	:	206-323-4668

Provider Business Practice Location Address
First Line	:	1001 BROADWAY
Second Line	:	SUITE 311
City	:	SEATTLE
State	:	WA
Zip	:	98122-4397
Country	:	US
Telephone Number	:	206-323-7659
Fax Number	:	206-323-4668

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	02/19/2016

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