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NPI Code Detail

MEDICARE: DR. DAVID PORTER SUTTON DMD

MEDICARE:  DR. DAVID PORTER SUTTON  DMD
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
1122300000XDentistD1343ID

General Provider Information

NPI Number : 1700853025
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID PORTER SUTTON DMD
Provider Business Mailing Address
First Line : 15 WEST 1ST NORTH
Second Line :
City : DOWNEY
State : ID
Zip : 83234
Country : US
Telephone Number : 208-897-5000
Fax Number : 208-897-5055
Provider Business Practice Location Address
First Line : 15 WEST FIRST NORTH
Second Line :
City : DOWNEY
State : ID
Zip : 83234
Country : US
Telephone Number : 208-897-5000
Fax Number : 208-897-5055
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2006
Last Update Date : 07/08/2007

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Directions to “ DR. DAVID PORTER SUTTON DMD” Practice Location

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