MEDICARE: DR. LYNNE SUTHERLAND D.M.D., M.S.

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	1223P0300X	Periodontics	30018894	OH
2	1223G0001X	General Practice Dentistry	30018894	OH

General Provider Information

NPI Number	:	1629291786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYNNE SUTHERLAND D.M.D., M.S.

Provider Business Mailing Address
First Line	:	1476 ASHFORD GLEN LN
Second Line	:
City	:	SAGAMORE HILLS
State	:	OH
Zip	:	44067-1682
Country	:	US
Telephone Number	:	330-285-4428
Fax Number	:

Provider Business Practice Location Address
First Line	:	790 ARLINGTON RIDGE
Second Line	:
City	:	NEW FRANKLIN
State	:	OH
Zip	:	44319
Country	:	US
Telephone Number	:	330-644-8070
Fax Number	:

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	01/19/2023

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