1689817769 NPI number — ABC DENTISTRY WEST OREM, PLLC

Table of content: ROSS T SUTTON MD (NPI 1225017072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689817769 NPI number — ABC DENTISTRY WEST OREM, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABC DENTISTRY WEST OREM, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689817769
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 SOUTHMORE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77502-1307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-944-6800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5505 WEST OREM DRIVE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77085
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-593-3300
Provider Business Practice Location Address Fax Number:
281-593-1616
Provider Enumeration Date:
04/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
JABBARY
Authorized Official First Name:
ARMIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
713-944-6800

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  18929 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 206551801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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