Provider Demographics
NPI:1285844894
Name:SUTTON, WAYNE FRANK (DDS)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:FRANK
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 1:1330 MEDICAL CENTER DR #1
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928
Mailing Address - Country:US
Mailing Address - Phone:707-585-2555
Mailing Address - Fax:707-585-3704
Practice Address - Street 1:1330 MEDICAL CENTER DR #1
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928
Practice Address - Country:US
Practice Address - Phone:707-585-2555
Practice Address - Fax:707-585-3704
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA446301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice