Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 5640 | NC |
NPI | 1003880980 |
---|---|
Provider Name | James Neal Sutherland |
First Address | Peterson Afb, CO 80914-1540 |
Second Address | Peterson Afb, CO 80914-1540 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 15/09/2008 |