Provider Demographics
NPI:1144232455
Name:SUTHERLAND, EDWIN E II (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:E
Last Name:SUTHERLAND
Suffix:II
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 S SANGRE RD
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-1847
Mailing Address - Country:US
Mailing Address - Phone:405-533-1555
Mailing Address - Fax:
Practice Address - Street 1:1605 S SANGRE RD
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-1847
Practice Address - Country:US
Practice Address - Phone:405-533-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK53901223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics