MEDICARE: DR. JOE ED SUTTON DDS

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	10981	TX

General Provider Information

NPI Number	:	1235238742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOE ED SUTTON DDS

Provider Business Mailing Address
First Line	:	PO BOX 1238 507 S MAIN
Second Line	:
City	:	HIGHLANDS
State	:	TX
Zip	:	77562
Country	:	US
Telephone Number	:	281-426-7591
Fax Number	:	281-426-5246

Provider Business Practice Location Address
First Line	:	507 S MAIN
Second Line	:
City	:	HIGHLANDS
State	:	TX
Zip	:	77562
Country	:	US
Telephone Number	:	281-426-7591
Fax Number	:	281-426-5246

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	07/08/2007

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