Provider Demographics
NPI:1568584902
Name:SUTHERLAND, HEATHER ANNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:ANNE
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16809 S 34TH WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-7877
Mailing Address - Country:US
Mailing Address - Phone:480-706-1686
Mailing Address - Fax:
Practice Address - Street 1:201 W GUADALUPE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-3332
Practice Address - Country:US
Practice Address - Phone:480-813-8890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ56951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice