MEDICARE: DR. ROBERT L SUTTON III DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3383	MS

General Provider Information

NPI Number	:	1205840824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT L SUTTON III DMD

Provider Business Mailing Address
First Line	:	15503 OAK LN # 300B
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39503-2697
Country	:	US
Telephone Number	:	228-832-3231
Fax Number	:	228-832-3508

Provider Business Practice Location Address
First Line	:	15503 OAK LN # 300B
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39503-2697
Country	:	US
Telephone Number	:	228-832-3231
Fax Number	:	228-832-3508

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	03/12/2026

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