Provider Demographics
NPI:1871683771
Name:NORTHSIDE ORAL SURGERY CNT DONALD M SUGGS DDSPC
Entity Type:Organization
Organization Name:NORTHSIDE ORAL SURGERY CNT DONALD M SUGGS DDSPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:M
Authorized Official - Last Name:SUGGS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-361-2200
Mailing Address - Street 1:1259 N KINGSHIGHWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63113-1647
Mailing Address - Country:US
Mailing Address - Phone:314-361-2200
Mailing Address - Fax:314-361-3211
Practice Address - Street 1:1259 N KINGSHIGHWAY BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63113-1647
Practice Address - Country:US
Practice Address - Phone:314-361-2200
Practice Address - Fax:314-361-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO009792261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical