Provider Demographics
NPI:1699894691
Name:VETTER, SUE KIM (DDS)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:KIM
Last Name:VETTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 N 34TH ST STE 170
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-9177
Mailing Address - Country:US
Mailing Address - Phone:206-547-4131
Mailing Address - Fax:206-547-8157
Practice Address - Street 1:2101 N 34TH ST STE 170
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-9177
Practice Address - Country:US
Practice Address - Phone:206-547-4131
Practice Address - Fax:206-547-8157
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE85361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice