Provider Demographics
NPI:1437224409
Name:SUTTON, JEANNE C (DMD)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:C
Last Name:SUTTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 N STONEWALL AVE
Mailing Address - Street 2:ROOM 544P
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73117
Mailing Address - Country:US
Mailing Address - Phone:405-271-8001
Mailing Address - Fax:405-271-3006
Practice Address - Street 1:1201 N STONEWALL AVE
Practice Address - Street 2:ROOM 494
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117
Practice Address - Country:US
Practice Address - Phone:405-271-8001
Practice Address - Fax:405-271-3006
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK55871223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice