Provider Demographics
NPI:1811184674
Name:RIVERA SUTHERLAND DDS INC
Entity type:Organization
Organization Name:RIVERA SUTHERLAND DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTHERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-318-3303
Mailing Address - Street 1:19831 YORBA LINDA BLVD
Mailing Address - Street 2:UNIT A
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-2851
Mailing Address - Country:US
Mailing Address - Phone:714-693-0990
Mailing Address - Fax:
Practice Address - Street 1:19831 YORBA LINDA BLVD
Practice Address - Street 2:UNIT A
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-2851
Practice Address - Country:US
Practice Address - Phone:714-693-0990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA438621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty