Provider Demographics
NPI:1326088170
Name:SUKURS, CHARLES P (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:P
Last Name:SUKURS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:CHUCK
Other - Middle Name:
Other - Last Name:SUKURS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:11479 LANTERN RD
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2947
Mailing Address - Country:US
Mailing Address - Phone:317-841-1996
Mailing Address - Fax:317-841-2819
Practice Address - Street 1:11479 LANTERN RD
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2947
Practice Address - Country:US
Practice Address - Phone:317-841-1996
Practice Address - Fax:317-841-2819
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007903122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist