Ian Thor Sutherland, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DEN-DEN-LIC-19483 Issued in MT

Practice address

2133 Pepperrell St
Jbsa Lackland, TX 78236-5313

Phone

(330) 354-6250

NPI assigned

May 23, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1558569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691712000000",
    "number": "1558928655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3625 9TH AVE S",
            "city": "GREAT FALLS",
            "state": "MT",
            "postal_code": "594053433",
            "telephone_number": "330-354-6250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2133 PEPPERRELL ST",
            "city": "JBSA LACKLAND",
            "state": "TX",
            "postal_code": "782365313",
            "telephone_number": "330-354-6250"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4881 Sugar Maple Dr",
            "address_purpose": "LOCATION",
            "city": "Wright Pat",
            "state": "OH",
            "postal_code": "454335529",
            "country_code": "US",
            "telephone_number": "937-257-0837",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7300 N Perimeter Rd",
            "address_purpose": "LOCATION",
            "city": "Malmstrom AFB",
            "state": "MT",
            "postal_code": "594026701",
            "country_code": "US",
            "telephone_number": "406-731-2528",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUTHERLAND",
        "first_name": "IAN",
        "middle_name": "THOR",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-05-23",
        "last_updated": "2023-08-11",
        "certification_date": "2023-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OH",
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MT",
            "license": "DEN-DEN-LIC-19483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "dds.sutherland@gmail.com",
            "affiliation": "N",
            "endpointDescription": "email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4464 Stonegate Dr Apt G",
            "city": "Beavercreek",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454306602",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "dds.sutherland@gmail.com",
            "affiliation": "N",
            "endpointDescription": "email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3625 9th Ave S",
            "city": "Great Falls",
            "state": "MT",
            "country_code": "US",
            "postal_code": "594053433",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Michael Stringer, DPT
• Emily L Sturgill, MD
• Jane Suh, DO
• Patrick Sullivan, PT, DPT
• Ryan Sumpter, MD
• Angela Marie Synatzske, DDS
• Wongelawit Deldil Tadesse, DDS
• Paul Tagashira, PA-C
• Gerald Wayne Talcott, PHD
• Brenda Karina Tanyi, PHYSICIAN ASSISTANT

• Dentist in Jbsa Lackland, TX
• Providers in Jbsa Lackland, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.