Provider Demographics
NPI:1437167806
Name:SULLENS, CAROLYN NICOLE (DDS PA)
Entity Type:Individual
Prefix:MISS
First Name:CAROLYN
Middle Name:NICOLE
Last Name:SULLENS
Suffix:
Gender:F
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1998 HENDERSONVILLE RD
Mailing Address - Street 2:SUITE 21
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2349
Mailing Address - Country:US
Mailing Address - Phone:828-681-2003
Mailing Address - Fax:828-684-4764
Practice Address - Street 1:1998 HENDERSONVILLE RD
Practice Address - Street 2:SUITE 21
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2349
Practice Address - Country:US
Practice Address - Phone:828-681-2003
Practice Address - Fax:828-684-4764
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC74921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC902P7Medicaid