Provider Demographics
NPI:1396976643
Name:SUTTER, GUIDO (DDS)
Entity type:Individual
Prefix:DR
First Name:GUIDO
Middle Name:
Last Name:SUTTER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19441 PINEHURST PL. E.
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-8455
Mailing Address - Country:US
Mailing Address - Phone:800-417-8205
Mailing Address - Fax:
Practice Address - Street 1:19441 PINEHURST PL. E.
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-8455
Practice Address - Country:US
Practice Address - Phone:800-417-8205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1685-75122300000X
LA2558122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist