Provider Demographics
NPI:1073652756
Name:JOHN D SAUTER DDS MDS ORTHO DENTAL GP INC
Entity Type:Organization
Organization Name:JOHN D SAUTER DDS MDS ORTHO DENTAL GP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MNGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:909-985-9215
Mailing Address - Street 1:23326 HAWTHORN BLVD
Mailing Address - Street 2:SUITE 190 BLD 10
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505
Mailing Address - Country:US
Mailing Address - Phone:310-378-8209
Mailing Address - Fax:310-375-1718
Practice Address - Street 1:23326 HAWTHORN BLVD
Practice Address - Street 2:SUITE 190 BLD 10
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505
Practice Address - Country:US
Practice Address - Phone:310-378-8209
Practice Address - Fax:310-375-1718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
204561223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty