Provider Demographics
NPI:1326102948
Name:SUTHERLAND, CHARLES E (DDS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
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 1:500 DALLAS ST
Mailing Address - Street 2:SUITE P-70
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-4800
Mailing Address - Country:US
Mailing Address - Phone:713-658-9591
Mailing Address - Fax:713-759-1717
Practice Address - Street 1:500 DALLAS ST
Practice Address - Street 2:SUITE P-70
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-4800
Practice Address - Country:US
Practice Address - Phone:713-658-9591
Practice Address - Fax:713-759-1717
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice