Healthcare Provider Details

I. General information

NPI: 1629127949
Provider Name (Legal Business Name): PHILLIP JONATHAN SUTTON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PJ SUTTON DDS

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E FOREST ST
BRIGHAM CITY UT
84302-2143
US

IV. Provider business mailing address

102 E FOREST ST
BRIGHAM CITY UT
84302-2143
US

V. Phone/Fax

Practice location:
  • Phone: 435-723-6009
  • Fax: 435-723-8361
Mailing address:
  • Phone: 435-723-6009
  • Fax: 435-723-8361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5154028-9922
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: