Individual
DR. KETAN ARUN SUKKAWALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1103 ROCK PRAIRIE RD STE 1001, COLLEGE STATION, TX 77845-8344
(979) 694-5200
(979) 694-5223
Mailing address
1109 ROCK PRAIRIE RD, STE 300, COLLEGE STATION, TX 77845-8651
(979) 694-5200
(979) 694-5223
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
19635
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009547301
—
TX
01
—
19635
DENTAL LICENSE
TX
Enumeration date
01/19/2007
Last updated
11/16/2017
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