MEDICARE: SUDDUTH MANAGEMENT GROUP LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1770420077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUDDUTH MANAGEMENT GROUP LLC

Provider Business Mailing Address
First Line	:	101 S MAIN ST STE A
Second Line	:
City	:	FOUNTAIN INN
State	:	SC
Zip	:	29644-1909
Country	:	US
Telephone Number	:	864-531-3300
Fax Number	:	864-531-3375

Provider Business Practice Location Address
First Line	:	101 S MAIN ST STE A
Second Line	:
City	:	FOUNTAIN INN
State	:	SC
Zip	:	29644-1909
Country	:	US
Telephone Number	:	864-531-3300
Fax Number	:	864-531-3375

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. EVAN PATRICK SUDDUTH
Credential	:	DMD
Telephone Number	:	864-531-3300

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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