Provider Demographics
NPI:1609396134
Name:SUTHAR, PC
Entity Type:Organization
Organization Name:SUTHAR, PC
Other - Org Name:SWANSEA DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:VATSAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTHAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-568-2077
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:SC
Mailing Address - Zip Code:29160-0400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:533 SAINT MATTHEWS RD
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:SC
Practice Address - Zip Code:29160-8814
Practice Address - Country:US
Practice Address - Phone:803-568-2077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX8125Medicaid