1679860068 NPI number — DR. MARGARETANNE HARTMAN SULLIVAN DDS

Table of content: DR. MARGARETANNE HARTMAN SULLIVAN DDS (NPI 1679860068)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679860068 NPI number — DR. MARGARETANNE HARTMAN SULLIVAN DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SULLIVAN
Provider First Name:
MARGARETANNE
Provider Middle Name:
HARTMAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARTMAN
Provider Other First Name:
MARGARET
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679860068
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
307 E 2ND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLENSBURG
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98926-3315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-962-9020
Provider Business Mailing Address Fax Number:
509-925-9022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
307 E 2ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLENSBURG
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98926-3315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-962-9020
Provider Business Practice Location Address Fax Number:
509-925-9022
Provider Enumeration Date:
07/06/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  WA8306 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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