Healthcare Provider Details

I. General information

NPI: 1285317990
Provider Name (Legal Business Name): GULF COAST DENTAL CARE OF BILOXI PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232A EISENHOWER DR
BILOXI MS
39531-3601
US

IV. Provider business mailing address

232A EISENHOWER DR
BILOXI MS
39531-3601
US

V. Phone/Fax

Practice location:
  • Phone: 228-388-9551
  • Fax: 228-388-9552
Mailing address:
  • Phone: 228-388-9551
  • Fax: 228-832-0186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT L SUTTON III
Title or Position: CO-OWNER
Credential: DMD
Phone: 228-832-3231