Healthcare Provider Details

I. General information

NPI: 1275672958
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: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 SAN BERNARDINO RD SUITE I
UPLAND CA
91786
US

IV. Provider business mailing address

1330 SAN BERNARDINO SUITE I
UPLAND CA
91786
US

V. Phone/Fax

Practice location:
  • Phone: 909-985-9215
  • Fax: 909-981-6506
Mailing address:
  • Phone: 909-985-9215
  • Fax: 909-981-6506

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: MRS. CINDY MENDOZA
Title or Position: OFFICE MANAGER
Credential: RDA
Phone: 909-985-9210