Provider Demographics
NPI:1699787333
Name:SUGG, GARY R (DDS MS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:R
Last Name:SUGG
Suffix:
Gender:M
Credentials:DDS MS
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Mailing Address - Street 1:4525 PARK ROAD
Mailing Address - Street 2:STE B104
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3723
Mailing Address - Country:US
Mailing Address - Phone:704-527-4895
Mailing Address - Fax:704-527-1407
Practice Address - Street 1:4525 PARK ROAD
Practice Address - Street 2:STE B104
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3723
Practice Address - Country:US
Practice Address - Phone:704-527-4895
Practice Address - Fax:704-527-1407
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC1201223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8998197Medicaid
NC98197OtherBCBS NC