Provider Demographics
NPI:1487739793
Name:SUTHERLAND AND CRAVATT DDS INC
Entity type:Organization
Organization Name:SUTHERLAND AND CRAVATT DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
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 1:927 DEEP VALLEY DR
Mailing Address - Street 2:SUITE 125
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3808
Mailing Address - Country:US
Mailing Address - Phone:310-377-9575
Mailing Address - Fax:
Practice Address - Street 1:927 DEEP VALLEY DR
Practice Address - Street 2:SUITE 125
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3808
Practice Address - Country:US
Practice Address - Phone:310-377-9575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA438621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty