Healthcare Provider Details

I. General information

NPI: 1497894174
Provider Name (Legal Business Name): JOHN D SAUTER DDS MDS ORTHO DENTAL GP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 BARRANCA PRWY SUITE 135
IRVINE CA
92604
US

IV. Provider business mailing address

4330 BARRANCA PRWY SUITE 135
IRVINE CA
92604
US

V. Phone/Fax

Practice location:
  • Phone: 949-857-1044
  • Fax: 949-857-1529
Mailing address:
  • Phone: 949-857-1044
  • Fax: 949-857-1529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number20456
License Number State

VIII. Authorized Official

Name: MRS. CINDY MENDOZA
Title or Position: OFFICE MANAGER
Credential: RDA
Phone: 909-985-9215