Active NPI
Kenton A Susott, DDS, MSD
- Orthodontics and Dentofacial Orthopedics Dentistry
- Indianapolis, IN
National Provider Identifier
1821208166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 12006912A
- Practice address
- 3916 Shore Dr
Indianapolis, IN 46254-2604 - Phone
- (317) 299-9506
- Fax
- (317) 290-3505
- NPI assigned
- May 23, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 12006912A | IN | Primary |
Addresses
Primary practice location
3916 Shore Dr
Indianapolis, IN 46254-2604
Mailing address
3916 Shore Dr
Indianapolis, IN 46254-2604
Phone (317) 299-9506
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12006912A | IN | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1821208166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3916 SHORE DR",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462542604",
"telephone_number": "317-299-9506",
"fax_number": "317-290-3505"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3916 SHORE DR",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462542604",
"telephone_number": "317-299-9506",
"fax_number": "317-290-3505"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUSOTT",
"first_name": "KENTON",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "DDS, MSD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "IN",
"license": "12006912A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.