Provider Demographics
NPI:1922447374
Name:SUTNICK, STEVEN ALLEN (DMD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ALLEN
Last Name:SUTNICK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W CYPRESS CREEK RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-2174
Mailing Address - Country:US
Mailing Address - Phone:954-617-6995
Mailing Address - Fax:954-678-9539
Practice Address - Street 1:19913 N. BISCAYNE BLVD SUITE 3
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180
Practice Address - Country:US
Practice Address - Phone:305-935-1400
Practice Address - Fax:954-757-0978
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 10650122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist