Provider Demographics
NPI:1235320433
Name:SUTLEY, CARMAN STUART (DDS)
Entity type:Individual
Prefix:MR
First Name:CARMAN
Middle Name:STUART
Last Name:SUTLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17611 S C & D BLVD
Mailing Address - Street 2:#18
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92225-8200
Mailing Address - Country:US
Mailing Address - Phone:760-921-2414
Mailing Address - Fax:760-921-2414
Practice Address - Street 1:17611 S C & D BLVD
Practice Address - Street 2:#18
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-8200
Practice Address - Country:US
Practice Address - Phone:760-921-2414
Practice Address - Fax:760-921-2414
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27843122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist