Provider Demographics
NPI:1043890296
Name:SULLIVAN, MARGARET LUCRETIA (DDS)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:LUCRETIA
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14500 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4302
Mailing Address - Country:US
Mailing Address - Phone:216-521-3727
Mailing Address - Fax:
Practice Address - Street 1:14500 MADISON AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4302
Practice Address - Country:US
Practice Address - Phone:216-521-3727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0271601223G0001X
SC99751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice