Provider Demographics
NPI:1245723196
Name:SUTER, KATELYN (DDS)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:SUTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14240 W 113TH TER
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66215-4825
Mailing Address - Country:US
Mailing Address - Phone:913-481-6791
Mailing Address - Fax:
Practice Address - Street 1:211 E 63RD ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64113-2224
Practice Address - Country:US
Practice Address - Phone:816-333-3711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180201811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice