1689088056 NPI number — MICHAEL J. SULLIVAN, D.D.S., INC

Table of content: (NPI 1689088056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689088056 NPI number — MICHAEL J. SULLIVAN, D.D.S., INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL J. SULLIVAN, D.D.S., INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689088056
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1882 HARD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43235-1996
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-761-9393
Provider Business Mailing Address Fax Number:
617-761-9363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1882 HARD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43235-1996
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-761-9393
Provider Business Practice Location Address Fax Number:
617-761-9363
Provider Enumeration Date:
06/13/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SULLIVAN
Authorized Official First Name:
ANDREA
Authorized Official Middle Name:
LEIGH
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
614-761-9393

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  30.016980 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1154672038 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0469265 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com