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General NPI Number Information
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NPI Number | 1659252450
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Entity Type | Organization
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Legal Business Name | SUTTON DENTAL PRACTICE INC.
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Dates
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Enumeration Date | 09/09/2025
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 3750 MONTGOMERY DR
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City | SANTA ROSA
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State | CA
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Zip | 95405-5215
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Country | US
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Telephone | 707-542-6772
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Fax |
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Provider Business Mailing Address
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Address Line | 19601 N BLACK CANYON HWY STE 201
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City | PHOENIX
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State | AZ
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Zip | 85027-4107
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | MERCEDES FIGUEROA
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Credential |
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Telephone | 623-289-3392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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