Mark A Sutor, DDS MSD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

12009269 Issued in IN

Practice address

379 S Park Ridge Rd
Bloomington, IN 47401-8574

Phone

(812) 333-4550

Fax

(812) 333-5789

NPI assigned

Mar 13, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1265565253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "379 S PARK RIDGE RD",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474018574",
            "telephone_number": "812-333-4550",
            "fax_number": "812-333-5789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "379 S PARK RIDGE RD",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474018574",
            "telephone_number": "812-333-4550",
            "fax_number": "812-333-5789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUTOR",
        "first_name": "MARK",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS MSD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "IN",
            "license": "12009269",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Surgical Associates of Bloomington, PC
• Surgicare LLC
• Taylor Sustarsic, SLPD
• Victoria Jolene Sutherland
• Gregory M Sutliff, M.D.
• Sutton Care Services LLC
• Emily Sutton
• Nicole Swann, APRN
• Jae Sweeny
• Brianna Ruth Swenson-Brack, LMHC

• Periodontics in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Periodontics in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.