Provider Demographics
NPI:1447557145
Name:SUTTON, MARK ROBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ROBERT
Last Name:SUTTON
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 1:391 E PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807-2579
Mailing Address - Country:US
Mailing Address - Phone:203-869-2066
Mailing Address - Fax:203-869-1477
Practice Address - Street 1:391 E PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2579
Practice Address - Country:US
Practice Address - Phone:203-869-2066
Practice Address - Fax:203-869-1477
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7365122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist