Provider Demographics
NPI:1295860690
Name:DRS SUTLLE & PIERCE PA
Entity Type:Organization
Organization Name:DRS SUTLLE & PIERCE PA
Other - Org Name:DUDLEY C CHANDLER DDS & W MARK SUTTLE DDS PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:SUTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:336-765-9224
Mailing Address - Street 1:2870 LYNDHURST AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4110
Mailing Address - Country:US
Mailing Address - Phone:336-765-9224
Mailing Address - Fax:336-765-2340
Practice Address - Street 1:2870 LYNDHURST AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4110
Practice Address - Country:US
Practice Address - Phone:336-765-9224
Practice Address - Fax:336-765-2340
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:W. MARK SUTTLE, DDS, MS, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-23
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC69291223P0300X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty