Provider Demographics
NPI:1790783686
Name:SUTTON DENTAL ARTS LLC
Entity Type:Organization
Organization Name:SUTTON DENTAL ARTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:541-672-4971
Mailing Address - Street 1:1729 W HARVARD AVE
Mailing Address - Street 2:#5
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-2788
Mailing Address - Country:US
Mailing Address - Phone:541-672-4971
Mailing Address - Fax:541-673-7200
Practice Address - Street 1:1729 W HARVARD AVE
Practice Address - Street 2:#5
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-2788
Practice Address - Country:US
Practice Address - Phone:541-672-4971
Practice Address - Fax:541-673-7200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IND68201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty