Provider Demographics
NPI:1407866684
Name:FARNHAM, SUTTON BURNS (PHD DDS)
Entity Type:Individual
Prefix:DR
First Name:SUTTON
Middle Name:BURNS
Last Name:FARNHAM
Suffix:
Gender:M
Credentials:PHD DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11528 SAN JOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:MANDARIN
Mailing Address - State:FL
Mailing Address - Zip Code:32223
Mailing Address - Country:US
Mailing Address - Phone:904-262-2551
Mailing Address - Fax:904-262-2930
Practice Address - Street 1:11528 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:MANDARIN
Practice Address - State:FL
Practice Address - Zip Code:32223
Practice Address - Country:US
Practice Address - Phone:904-262-2551
Practice Address - Fax:904-262-2930
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8860122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist