MEDICARE: DR. TODD S SUEKAWA 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	122300000X	Dentist	953123229921	UT

General Provider Information

NPI Number	:	1932260528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TODD S SUEKAWA DDS

Provider Business Mailing Address
First Line	:	2178 S 900 E SUITE 5
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84106-2388
Country	:	US
Telephone Number	:	801-487-4606
Fax Number	:	801-487-6198

Provider Business Practice Location Address
First Line	:	2178 S 900 E SUITE 5
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84106-2388
Country	:	US
Telephone Number	:	801-487-4606
Fax Number	:	801-487-6198

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

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	07/08/2007

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