Provider Demographics
NPI:1932327368
Name:CHARLES M SAUTER, DDS
Entity Type:Organization
Organization Name:CHARLES M SAUTER, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:M
Authorized Official - Last Name:SAUTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-288-4877
Mailing Address - Street 1:18640 LBJ FWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6034
Mailing Address - Country:US
Mailing Address - Phone:972-288-4401
Mailing Address - Fax:
Practice Address - Street 1:18640 LBJ FWY
Practice Address - Street 2:SUITE 202
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6034
Practice Address - Country:US
Practice Address - Phone:972-288-4401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15824122300000X
TX16437122300000X
TX109971223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110952201Medicaid
TX009782601Medicaid