Healthcare Provider Details

I. General information

NPI: 1003208984
Provider Name (Legal Business Name): SAUTER ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2015
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 E PACIFIC COAST HIGHWAY SUITE D
LONG BEACH CA
90806
US

IV. Provider business mailing address

1075 E PACIFIC COAST HWY SUITE D
LONG BEACH CA
90806-5089
US

V. Phone/Fax

Practice location:
  • Phone: 714-264-3998
  • Fax: 909-985-6506
Mailing address:
  • Phone: 714-264-3998
  • Fax: 909-985-6506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JOHN SAUTER
Title or Position: ORTHODONTIST
Credential:
Phone: 714-264-3998