Provider Demographics
NPI:1245469501
Name:SUTHERLAND, ERIC H (DMD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:H
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 1:3766 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-1823
Mailing Address - Country:US
Mailing Address - Phone:970-304-1273
Mailing Address - Fax:970-304-6979
Practice Address - Street 1:3766 W 10TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-1823
Practice Address - Country:US
Practice Address - Phone:970-304-1273
Practice Address - Fax:970-304-6979
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice