Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 2007017222 | MO |
N | 1223G0001X | General Practice | 2007017222 | MO |
N | 213EG0000X | General Practice | 2007017222 | MO |
NPI | 1548469398 |
---|---|
Provider Name | Dr. Samantha Jean Sutton |
First Address | Anderson, MO 64831-1136 |
Second Address | Mound City, MO 64470-1717 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2007 |
Last Update Date | 10/11/2021 |