Provider Demographics
NPI:1922501709
Name:SUTHERLAND, MCGARRETT THOMAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:MCGARRETT
Middle Name:THOMAS
Last Name:SUTHERLAND
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4103 SE RURAL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-7844
Mailing Address - Country:US
Mailing Address - Phone:510-507-2640
Mailing Address - Fax:
Practice Address - Street 1:4103 SE RURAL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-7844
Practice Address - Country:US
Practice Address - Phone:510-507-2640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-17
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD110921223G0001X
WADR60846553122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223G0001XDental ProvidersDentistGeneral Practice