Provider Demographics
NPI:1619371234
Name:GUY C SUTTON A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:GUY C SUTTON A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-278-1454
Mailing Address - Street 1:5075 RUFFIN RD
Mailing Address - Street 2:C
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1698
Mailing Address - Country:US
Mailing Address - Phone:858-278-1454
Mailing Address - Fax:
Practice Address - Street 1:5075 RUFFIN RD
Practice Address - Street 2:C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1698
Practice Address - Country:US
Practice Address - Phone:858-278-1454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42234122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty