Provider Demographics
NPI:1457426538
Name:SUTTER, BEN A (DMD)
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:A
Last Name:SUTTER
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 1:4734 RIVER RD N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-4536
Mailing Address - Country:US
Mailing Address - Phone:503-463-4663
Mailing Address - Fax:503-463-4666
Practice Address - Street 1:4734 RIVER RD N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-4536
Practice Address - Country:US
Practice Address - Phone:503-463-4663
Practice Address - Fax:503-463-4666
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD87281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice