Provider Demographics
NPI:1285666255
Name:SULLIVAN, MICHAEL E (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
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 1:386 N YORK ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2363
Mailing Address - Country:US
Mailing Address - Phone:630-530-0770
Mailing Address - Fax:630-530-9287
Practice Address - Street 1:386 N YORK ST
Practice Address - Street 2:SUITE 203
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2363
Practice Address - Country:US
Practice Address - Phone:630-530-0770
Practice Address - Fax:630-530-9287
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice