Healthcare Provider Details

I. General information

NPI: 1295810505
Provider Name (Legal Business Name): STEVEN J SUTHERLAND DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6226 E SPRING ST STE 230
LONG BEACH CA
90815-1457
US

IV. Provider business mailing address

6226 E SPRING ST STE 230
LONG BEACH CA
90815-1457
US

V. Phone/Fax

Practice location:
  • Phone: 562-421-3336
  • Fax: 562-429-4529
Mailing address:
  • Phone: 562-421-3336
  • Fax: 562-429-4529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number43862
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number43862
License Number StateCA

VIII. Authorized Official

Name: STEVE SUTHERLAND
Title or Position: OWNER
Credential: DDS
Phone: 562-421-3336