Provider Demographics
NPI:1629127949
Name:SUTTON, PHILLIP JONATHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:JONATHAN
Last Name:SUTTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:PJ
Other - Middle Name:
Other - Last Name:SUTTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:102 E FOREST ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-2143
Mailing Address - Country:US
Mailing Address - Phone:435-723-6009
Mailing Address - Fax:435-723-8361
Practice Address - Street 1:102 E FOREST ST
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-2143
Practice Address - Country:US
Practice Address - Phone:435-723-6009
Practice Address - Fax:435-723-8361
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5154028-99221223G0001X
WA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice