Provider Demographics
NPI:1093142929
Name:EDWARD G. SUTTER DDS
Entity Type:Organization
Organization Name:EDWARD G. SUTTER DDS
Other - Org Name:SENECA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:SUTTER
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-323-7659
Mailing Address - Street 1:1422 SENECA ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2830
Mailing Address - Country:US
Mailing Address - Phone:206-323-7659
Mailing Address - Fax:206-323-4668
Practice Address - Street 1:1422 SENECA ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2830
Practice Address - Country:US
Practice Address - Phone:206-323-7659
Practice Address - Fax:206-323-4668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE28911223G0001X
WADE89971223G0001X
WADE28531223G0001X
WADE44021223P0300X
WADH60180349124Q00000X
WADH1320124Q00000X
WAD160028280126800000X
WAD160029707126800000X
WAD160030003126800000X
WAD160274140126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
No126800000XDental ProvidersDental AssistantGroup - Single Specialty