Active NPI
Mark David Sutter, DDS
- Periodontics
- Fairfield, CA
National Provider Identifier
1871898130
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 37169
- Practice address
- 3700 Hilborn Rd Ste 300
Suite 300
Fairfield, CA 94534-7996 - Phone
- (707) 425-5511
- Fax
- (707) 425-5522
- NPI assigned
- Jan 18, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 37169 | CA | Primary |
Addresses
Primary practice location
3700 Hilborn Rd Ste 300
Suite 300
Fairfield, CA 94534-7996
Mailing address
3700 Hilborn Rd Ste 300
Suite 300
Fairfield, CA 94534-7996
Phone (707) 425-5511
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 68-0313477 | Other | CA | DENTAL INSURANCE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37169 | CA | MD | Registered Respiratory Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1295308800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1477353600000",
"number": "1871898130",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3700 HILBORN RD STE 300",
"address_2": "SUITE 300",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945347996",
"telephone_number": "707-425-5511",
"fax_number": "707-425-5522"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3700 HILBORN RD STE 300",
"address_2": "SUITE 300",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945347996",
"telephone_number": "707-425-5511",
"fax_number": "707-425-5522"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUTTER",
"first_name": "MARK",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-01-18",
"last_updated": "2016-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "37169",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL INSURANCE",
"identifier": "68-0313477",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.