MEDICARE: DR. CRAIG S SUTTON D.D.S.

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	1223P0106X	Oral and Maxillofacial Pathology Dentistry	10082	TX

General Provider Information

NPI Number	:	1538278320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG S SUTTON D.D.S.

Provider Business Mailing Address
First Line	:	PO BOX 381359
Second Line	:
City	:	DUNCANVILLE
State	:	TX
Zip	:	75138-1359
Country	:	US
Telephone Number	:	972-296-2921
Fax Number	:	972-296-0277

Provider Business Practice Location Address
First Line	:	519 W WHEATLAND RD
Second Line	:
City	:	DUNCANVILLE
State	:	TX
Zip	:	75116-4515
Country	:	US
Telephone Number	:	972-296-2921
Fax Number	:	972-296-0277

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	07/08/2007

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