Sutton Burns Farnham, PHD DDS
Individual provider Active NPI Dentist · Mandarin, FL
NPI 1407866684 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1407866684
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 8860 (FL)
- Practice address
- 11528 San Jose Blvd
Mandarin, FL 32223 - Phone
- (904) 262-2551
- Fax
- (904) 262-2930
- NPI assigned
- Aug 9, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8860 | FL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Farnham & Farnham PA | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 8860 | FL | Yes |
Addresses
Primary practice location
11528 San Jose Blvd
Mandarin, FL 32223
Mailing address
11528 San Jose Blvd
Mandarin, FL 32223
Phone (904) 262-2551
Other providers in Mandarin, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.