Provider Demographics
NPI:1902141682
Name:SUTHAR, VATSAL (DMD)
Entity Type:Individual
Prefix:DR
First Name:VATSAL
Middle Name:
Last Name:SUTHAR
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 1:625 CONSTITUTION DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29154-8190
Mailing Address - Country:US
Mailing Address - Phone:803-773-5413
Mailing Address - Fax:
Practice Address - Street 1:625 CONSTITUTION DR
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29154-8190
Practice Address - Country:US
Practice Address - Phone:803-773-5413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC81251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice