Healthcare Provider Details

I. General information

NPI: 1841746427
Provider Name (Legal Business Name): CASEY D. SUTHERLAND, DMD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 WAPATO WAY
MANSON WA
98831
US

IV. Provider business mailing address

PO BOX 405
MANSON WA
98831-0405
US

V. Phone/Fax

Practice location:
  • Phone: 509-687-9221
  • Fax: 509-687-9201
Mailing address:
  • Phone: 509-687-9221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: CASEY D SUTHERLAND
Title or Position: OWNER
Credential: DMD
Phone: 509-687-9221