MEDICARE: DR. WALTER A SUSTEK JR. DMD

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	2444	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760585764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WALTER A SUSTEK JR. DMD

Provider Business Mailing Address
First Line	:	975 NORTH CHURCH STREET
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29303
Country	:	US
Telephone Number	:	864-582-4308
Fax Number	:	864-596-4492

Provider Business Practice Location Address
First Line	:	3004 NORTH MAIN STREET
Second Line	:
City	:	ANDERSON
State	:	SC
Zip	:	29621
Country	:	US
Telephone Number	:	864-224-8106
Fax Number	:	864-261-3429

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	07/08/2007

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