Healthcare Provider Details

I. General information

NPI: 1487793162
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: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6226 EAST SPRING STREET SUITE 200
LONG BEACH CA
90815
US

IV. Provider business mailing address

6226 EAST SPRING STREET SUITE 200
LONG BEACH CA
90815
US

V. Phone/Fax

Practice location:
  • Phone: 562-421-3336
  • Fax: 562-421-3336
Mailing address:
  • Phone: 562-421-3336
  • Fax: 562-421-3336

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 MNGR
Credential: RDA
Phone: 909-985-9215