Provider Demographics
NPI:1295859957
Name:SUTTON, ROBERT (DMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
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 1:4912 SOUTHFORK DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2042
Mailing Address - Country:US
Mailing Address - Phone:863-648-5353
Mailing Address - Fax:863-648-5253
Practice Address - Street 1:4912 SOUTHFORK DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2042
Practice Address - Country:US
Practice Address - Phone:863-648-5353
Practice Address - Fax:863-648-5253
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11529122300000X
332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No122300000XDental ProvidersDentist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies