Provider Demographics
NPI:1235223017
Name:SULLIVAN, GABRIEL PAUL (DDS)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:PAUL
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 1:475 N OLD TROY RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:TN
Mailing Address - Zip Code:38260
Mailing Address - Country:US
Mailing Address - Phone:731-536-5210
Mailing Address - Fax:
Practice Address - Street 1:1007 E REELFOOT AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261
Practice Address - Country:US
Practice Address - Phone:731-885-2277
Practice Address - Fax:731-885-8852
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS8584122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist