Provider Demographics
NPI:1235495821
Name:SULLIVAN & ASSOCIATES FAMILY DENTISTRY, PC
Entity Type:Organization
Organization Name:SULLIVAN & ASSOCIATES FAMILY DENTISTRY, PC
Other - Org Name:SULLIVAN FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-362-4636
Mailing Address - Street 1:223 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:NE
Mailing Address - Zip Code:68467-3040
Mailing Address - Country:US
Mailing Address - Phone:402-362-4636
Mailing Address - Fax:402-362-6098
Practice Address - Street 1:223 E 8TH ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467-3040
Practice Address - Country:US
Practice Address - Phone:402-362-4636
Practice Address - Fax:402-362-6098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty