MEDICARE: STEVEN J SUTHERLAND 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	122300000X	Dentist
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1992342406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVEN J SUTHERLAND DDS INC

Provider Business Mailing Address
First Line	:	550 DEEP VALLEY DR STE 347
Second Line	:
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-7603
Country	:	US
Telephone Number	:	310-377-9575
Fax Number	:	310-541-2133

Provider Business Practice Location Address
First Line	:	550 DEEP VALLEY DR STE 347
Second Line	:
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-7603
Country	:	US
Telephone Number	:	310-377-9575
Fax Number	:	310-541-2133

Authorized Official
Title or Position	:	OWNER
Name	:	STEVEN JAMES SUTHERLAND
Credential	:	DDS
Telephone Number	:	310-291-9880

Provider Enumeration Date	:	12/03/2019
Last Update Date	:	12/03/2019

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