Provider Demographics
NPI:1124678198
Name:SUTTON, KRISTI MARIE (RDH)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:MARIE
Last Name:SUTTON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1045
Mailing Address - Country:US
Mailing Address - Phone:404-451-0070
Mailing Address - Fax:
Practice Address - Street 1:122 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-9164
Practice Address - Country:US
Practice Address - Phone:517-740-7422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2902010730OtherSTATE OF MICHIGAN LICENSE