Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 5390 | OK |
NPI | 1144232455 |
---|---|
Provider Name | Dr. Edwin E Sutherland II |
First Address | Stillwater, OK 74074-1847 |
Second Address | Stillwater, OK 74074-1847 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 08/07/2007 |