Provider Demographics
NPI:1811243116
Name:SUTTER DENTAL PC
Entity type:Organization
Organization Name:SUTTER DENTAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VESNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-745-8300
Mailing Address - Street 1:7728 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707-4124
Mailing Address - Country:US
Mailing Address - Phone:773-745-8300
Mailing Address - Fax:
Practice Address - Street 1:7728 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707-4124
Practice Address - Country:US
Practice Address - Phone:773-745-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-020137332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies