=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841377223
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN HARRY SUTHERLAND D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1775 E 14 MILE RD
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48009-7206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-642-5466
-----------------------------------------------------
Fax | 248-646-3444
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1775 E 14 MILE RD
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48009-7206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-642-5466
-----------------------------------------------------
Fax | 248-646-3444
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 13317
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------