MEDICARE: JAMES C SUIT DDS, PA

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	D3894	AZ

General Provider Information

NPI Number	:	1811009129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES C SUIT DDS, PA

Provider Business Mailing Address
First Line	:	1578 N HWY 89
Second Line	:	STE 1
City	:	CHINO VALLEY
State	:	AZ
Zip	:	86323-7624
Country	:	US
Telephone Number	:	928-636-6227
Fax Number	:	928-636-6228

Provider Business Practice Location Address
First Line	:	1578 N HWY 89
Second Line	:	STE 1
City	:	CHINO VALLEY
State	:	AZ
Zip	:	86323-7624
Country	:	US
Telephone Number	:	928-636-6227
Fax Number	:	928-636-6228

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	DR. JAMES C SUIT
Credential	:	DDS
Telephone Number	:	928-636-6227

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	10/29/2012

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