Provider Demographics
NPI:1992066757
Name:SUTTON, DAVID I (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:I
Last Name:SUTTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 LAKE WASHINGTON RD STE 3
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-3400
Mailing Address - Country:US
Mailing Address - Phone:321-259-0217
Mailing Address - Fax:321-242-0667
Practice Address - Street 1:2900 LAKE WASHINGTON RD STE 3
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3400
Practice Address - Country:US
Practice Address - Phone:321-259-0217
Practice Address - Fax:321-242-0667
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19823122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist