Provider Demographics
NPI:1235225178
Name:SUTTON, JOHN BASIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BASIL
Last Name:SUTTON
Suffix:
Gender:M
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:PO BOX 965
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25402
Mailing Address - Country:US
Mailing Address - Phone:304-267-2928
Mailing Address - Fax:304-267-0720
Practice Address - Street 1:1226 SHEPHERDSTOWN ROAD
Practice Address - Street 2:FAIRVIEW DENTAL BLDG
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401
Practice Address - Country:US
Practice Address - Phone:304-267-2928
Practice Address - Fax:304-267-0720
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1877122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1877OtherBOARD DENTAL EXAMINERS