Individual
DR. KENTON A SUSOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MSD
Contact information
Practice address
3916 SHORE DR, INDIANAPOLIS, IN 46254-2604
(317) 299-9506
(317) 290-3505
Mailing address
3916 SHORE DR, INDIANAPOLIS, IN 46254-2604
(317) 299-9506
(317) 290-3505
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
12006912A
IN
Other
Enumeration date
05/23/2007
Last updated
07/08/2007
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