Individual
DR. BRADLEY W SUTTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
475 YELLOWSTONE AVE, STE D, POCATELLO, ID 83201
(208) 232-3500
(208) 232-3505
Mailing address
475 YELLOWSTONE AVE, STE D, POCATELLO, ID 83201
(208) 232-3500
(208) 232-3505
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3963
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6P055
BLUE CROSS BLUE SHIELD OF
—
Enumeration date
09/27/2006
Last updated
07/08/2007
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