Healthcare Provider Details

I. General information

NPI: 1417930108
Provider Name (Legal Business Name): JOHN DELL SAUTER DDS MDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: JOHN DELL SAUTER DDS MDS INC

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 SAN BERNADINO RD STE I
UPLAND CA
91786
US

IV. Provider business mailing address

20171 ORCHID ST
NEWPORT BEACH CA
92660
US

V. Phone/Fax

Practice location:
  • Phone: 909-985-9215
  • Fax: 949-857-1526
Mailing address:
  • Phone: 949-752-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number20000456
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: