Provider Demographics
NPI:1770507055
Name:SUTTON, SHANETTA LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHANETTA
Middle Name:LYNN
Last Name:SUTTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6567 RIVERBEND DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-2677
Mailing Address - Country:US
Mailing Address - Phone:937-274-2991
Mailing Address - Fax:
Practice Address - Street 1:515 SHILOH SPRINGS RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-3135
Practice Address - Country:US
Practice Address - Phone:937-275-9585
Practice Address - Fax:937-275-9858
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH214941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice