Provider Demographics
NPI:1073524807
Name:SULLINS, JERRY E (DDS)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:E
Last Name:SULLINS
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 1:104 HAZEL PATH
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3844
Mailing Address - Country:US
Mailing Address - Phone:615-824-7220
Mailing Address - Fax:
Practice Address - Street 1:104 HAZEL PATH
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3844
Practice Address - Country:US
Practice Address - Phone:615-824-7220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice