Provider Demographics
NPI:1376960021
Name:SUE KIM VETTER, DDS, PLLC
Entity Type:Organization
Organization Name:SUE KIM VETTER, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUE
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:VETTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-547-4131
Mailing Address - Street 1:2101 N 34TH ST STE 170
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-9177
Mailing Address - Country:US
Mailing Address - Phone:206-547-4131
Mailing Address - Fax:206-547-8157
Practice Address - Street 1:2101 N 34TH ST STE 170
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-9177
Practice Address - Country:US
Practice Address - Phone:206-547-4131
Practice Address - Fax:206-547-8157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE8536122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty