Provider Demographics
NPI:1316113962
Name:DR. BETTY K. SUTTON
Entity type:Organization
Organization Name:DR. BETTY K. SUTTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:K
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:919-231-4569
Mailing Address - Street 1:2949 NEW BERN AVE
Mailing Address - Street 2:SUITE 109A
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1248
Mailing Address - Country:US
Mailing Address - Phone:919-231-4569
Mailing Address - Fax:919-847-0362
Practice Address - Street 1:2949 NEW BERN AVE
Practice Address - Street 2:SUITE 109A
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1248
Practice Address - Country:US
Practice Address - Phone:919-231-4569
Practice Address - Fax:919-847-0362
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. BETTY K. SUTTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-05
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC4144261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental