Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 10082 | TX |
NPI | 1538278320 |
---|---|
Provider Name | Dr. Craig S Sutton |
First Address | Duncanville, TX 75138-1359 |
Second Address | Duncanville, TX 75116-4515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 08/07/2007 |