Individual
DR. IAN THOR SUTHERLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2133 PEPPERRELL ST, JBSA LACKLAND, TX 78236-5313
(330) 354-6250
Mailing address
3625 9TH AVE S, GREAT FALLS, MT 59405-3433
(330) 354-6250
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DEN-DEN-LIC-19483
MT
390200000X
Student in an Organized Health Care Education/Training Program
—
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/23/2019
Last updated
08/11/2023
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