Provider Demographics
NPI:1396924437
Name:SUTHERLAND, JOHN SCOTT (DDS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:SCOTT
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 1:2701 OLD EUREKA WAY
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001
Mailing Address - Country:US
Mailing Address - Phone:530-243-9425
Mailing Address - Fax:530-243-1848
Practice Address - Street 1:2701 OLD EUREKA WAY
Practice Address - Street 2:SUITE 1A
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001
Practice Address - Country:US
Practice Address - Phone:530-243-9425
Practice Address - Fax:530-243-1848
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA490051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice