MEDICARE: DR. DANNON WAYNE SUTHERLAND D.M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	5845	AL

General Provider Information

NPI Number	:	1255626339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANNON WAYNE SUTHERLAND D.M.D

Provider Business Mailing Address
First Line	:	238 BROOKLEY AVE SW
Second Line	:	JOINT BASE ANACOSTIA
City	:	BOLLING AFB
State	:	DC
Zip	:	20032-7704
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	238 BROOKLEY AVE SW
Second Line	:	JOINT BASE ANACOSTIA
City	:	BOLLING AFB
State	:	DC
Zip	:	20032-7704
Country	:	US
Telephone Number	:	202-767-5382
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2011
Last Update Date	:	06/16/2011

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