Provider Demographics
NPI:1003880980
Name:SUTHERLAND, JAMES NEAL (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:NEAL
Last Name:SUTHERLAND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 VINCENT ST
Mailing Address - Street 2:21ST MEDICAL GROUP SGHQ CREDENTIALS
Mailing Address - City:PETERSON AFB
Mailing Address - State:CO
Mailing Address - Zip Code:80914-1540
Mailing Address - Country:US
Mailing Address - Phone:719-556-1060
Mailing Address - Fax:719-556-9677
Practice Address - Street 1:559 VINCENT ST
Practice Address - Street 2:
Practice Address - City:PETERSON AFB
Practice Address - State:CO
Practice Address - Zip Code:80914-1540
Practice Address - Country:US
Practice Address - Phone:719-556-1060
Practice Address - Fax:719-556-9677
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5640122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist