Provider Demographics
NPI:1871898130
Name:SUTTER, MARK DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:SUTTER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3700 HILBORN RD STE 300
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-7996
Mailing Address - Country:US
Mailing Address - Phone:707-425-5511
Mailing Address - Fax:707-425-5522
Practice Address - Street 1:3700 HILBORN RD STE 300
Practice Address - Street 2:SUITE 300
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-7996
Practice Address - Country:US
Practice Address - Phone:707-425-5511
Practice Address - Fax:707-425-5522
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA371691223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA68-0313477OtherDENTAL INSURANCE