Provider Demographics
NPI:1275535460
Name:SUTTER, RICHARD JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOHN
Last Name:SUTTER
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 1:01810 SW RADCLIFFE RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-7964
Mailing Address - Country:US
Mailing Address - Phone:503-636-2418
Mailing Address - Fax:503-675-0046
Practice Address - Street 1:14210 SE SUNNYSIDE RD
Practice Address - Street 2:STE 300
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5243
Practice Address - Country:US
Practice Address - Phone:503-558-0410
Practice Address - Fax:503-558-8757
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD46981223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics