Provider Demographics
NPI:1023201209
Name:SULLIVAN, FRANK VINIC (DDS)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:VINIC
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2880
Mailing Address - Street 2:5436 COMMERCE ST
Mailing Address - City:SAINT FRANCISVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70775-2880
Mailing Address - Country:US
Mailing Address - Phone:225-635-4422
Mailing Address - Fax:225-635-2171
Practice Address - Street 1:5436 COMMERCE
Practice Address - Street 2:
Practice Address - City:SAINT FRANCISVILLE
Practice Address - State:LA
Practice Address - Zip Code:70775-2880
Practice Address - Country:US
Practice Address - Phone:225-635-4422
Practice Address - Fax:225-635-2171
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA50621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice