Ketan Arun Sukkawala, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

19635 Issued in TX

Practice address

1103 Rock Prairie Rd Ste 1001
College Station, TX 77845-8344

Phone

(979) 694-5200

Fax

(979) 694-5223

NPI assigned

Jan 19, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Brazos Valley Smiles, PC

  • Dental Clinic/Center
  • College Station, TX
  • NPI 1386924694
  NPD (past) Authorized official

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510790400000",
    "number": "1710030077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1109 ROCK PRAIRIE RD",
            "address_2": "STE 300",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778458651",
            "telephone_number": "979-694-5200",
            "fax_number": "979-694-5223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 ROCK PRAIRIE RD STE 1001",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778458344",
            "telephone_number": "979-694-5200",
            "fax_number": "979-694-5223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUKKAWALA",
        "first_name": "KETAN",
        "middle_name": "ARUN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-19",
        "last_updated": "2017-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "19635",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "19635",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009547301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Strong Roots Physical Therapy, PLLC
• Edward Anthony Styduhar Jr., D.O.
• Andrea Suarez
• Ben L Sueoka, M.D.
• Jothi A Sukkawala, M.D.
• Sulik Sheridan Anderson Inc
• Sulik Sheridan Rock Priarie Inc.
• Amy Elizabeth Sullivan, LPC
• Kelly Ingrid Sullivan, MD
• Seth J. Sullivan, M.D.

• Pediatric Dentistry in College Station, TX
• Providers in College Station, TX by specialty
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.