1982865986 NPI number — DR. JOHN V. SULLIVANT, D.D.S. P.A.

Table of content: MS. KAREN LOUISE PRICE MSW (NPI 1497757892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982865986 NPI number — DR. JOHN V. SULLIVANT, D.D.S. P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. JOHN V. SULLIVANT, D.D.S. P.A.
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:
1982865986
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
727 N CARDINAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNTAIN HOME
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72653-3253
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-425-4242
Provider Business Mailing Address Fax Number:
870-425-4243

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
727 N CARDINAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAIN HOME
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72653-3253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-425-4242
Provider Business Practice Location Address Fax Number:
870-425-4243
Provider Enumeration Date:
06/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SULLIVANT
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
VIRGIL
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
870-425-4242

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  AR2788 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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