MEDICARE: SUTHERLAND AND CRAVATT DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	43862	CA

General Provider Information

NPI Number	:	1487739793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUTHERLAND AND CRAVATT DDS INC

Provider Business Mailing Address
First Line	:	927 DEEP VALLEY DR
Second Line	:	SUITE 125
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-3808
Country	:	US
Telephone Number	:	310-377-9575
Fax Number	:

Provider Business Practice Location Address
First Line	:	927 DEEP VALLEY DR
Second Line	:	SUITE 125
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-3808
Country	:	US
Telephone Number	:	310-377-9575
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STEVE SUTHERLAND
Credential	:	DDS
Telephone Number	:	310-318-3303

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	08/22/2020

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