Provider Demographics
NPI:1992106272
Name:DANNON W SUTHERLAND DMD LLC
Entity type:Organization
Organization Name:DANNON W SUTHERLAND DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTHERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:504-361-5367
Mailing Address - Street 1:307 GRETNA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-4994
Mailing Address - Country:US
Mailing Address - Phone:504-361-5367
Mailing Address - Fax:504-368-4846
Practice Address - Street 1:307 GRETNA BLVD STE A
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-4994
Practice Address - Country:US
Practice Address - Phone:504-361-5367
Practice Address - Fax:504-368-4846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6506261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental