Healthcare Provider Details

I. General information

NPI: 1992342406
Provider Name (Legal Business Name): STEVEN J SUTHERLAND DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

550 DEEP VALLEY DR STE 347
ROLLING HILLS ESTATES CA
90274-7603
US

IV. Provider business mailing address

550 DEEP VALLEY DR STE 347
ROLLING HILLS ESTATES CA
90274-7603
US

V. Phone/Fax

Practice location:
  • Phone: 310-377-9575
  • Fax: 310-541-2133
Mailing address:
  • Phone: 310-377-9575
  • Fax: 310-541-2133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: STEVEN JAMES SUTHERLAND
Title or Position: OWNER
Credential: DDS
Phone: 310-291-9880