Provider Demographics
NPI:1306513098
Name:KATHRYN SUTTON DDS INC
Entity type:Organization
Organization Name:KATHRYN SUTTON DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-532-6542
Mailing Address - Street 1:419 VERNON ST
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-1637
Mailing Address - Country:US
Mailing Address - Phone:740-532-6542
Mailing Address - Fax:
Practice Address - Street 1:419 VERNON ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-1637
Practice Address - Country:US
Practice Address - Phone:740-532-6542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KATHRYN SUTTON DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty