Provider Demographics
NPI:1982868139
Name:SUTTLES, PHILLIP REID
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:REID
Last Name:SUTTLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 MILL PLAIN RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-5191
Mailing Address - Country:US
Mailing Address - Phone:203-748-5822
Mailing Address - Fax:
Practice Address - Street 1:39 MILL PLAIN RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-5191
Practice Address - Country:US
Practice Address - Phone:203-748-5822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005767122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist