Provider Demographics
NPI:1851959076
Name:SUTTON, TAYLOR JARED (DMD)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:JARED
Last Name:SUTTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 PARK ROW W APT 423
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-1147
Mailing Address - Country:US
Mailing Address - Phone:973-641-6119
Mailing Address - Fax:
Practice Address - Street 1:18 DOWLING VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-8267
Practice Address - Country:US
Practice Address - Phone:401-762-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN034911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice