Provider Demographics
NPI:1114092509
Name:SULLIVAN, JOHN E (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
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 1:511 EAST THORNHILL DRIVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2438
Mailing Address - Country:US
Mailing Address - Phone:630-665-7350
Mailing Address - Fax:630-665-0004
Practice Address - Street 1:511 THORNHILL DR
Practice Address - Street 2:SUITE H
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2795
Practice Address - Country:US
Practice Address - Phone:630-665-7350
Practice Address - Fax:630-665-0004
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190186391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice