Provider Demographics
NPI:1750390241
Name:SUEKERT, HARRY MANFRED (DDS)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:MANFRED
Last Name:SUEKERT
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 1:3500 RINGGOLD RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37412-1271
Mailing Address - Country:US
Mailing Address - Phone:423-698-8651
Mailing Address - Fax:423-698-4692
Practice Address - Street 1:3500 RINGGOLD RD
Practice Address - Street 2:SUITE 1
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37412-1271
Practice Address - Country:US
Practice Address - Phone:423-698-8651
Practice Address - Fax:423-698-4692
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901015953122300000X
TNDS0000008664122300000X
CA57093122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN26-2420642OtherFED TAX ID
MI1951560080OtherBC/BS MEDICAL
MI159530OtherBC/BS DENTAL
MI15953OtherDELTA DENTAL
MI38-3340423OtherFED TAX ID #