Provider Demographics
NPI:1467676700
Name:SULLIVAN, RICHARD HUGH (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:HUGH
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 1:5023 HARPETH DR.
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027
Mailing Address - Country:US
Mailing Address - Phone:615-373-1012
Mailing Address - Fax:615-373-3819
Practice Address - Street 1:5023 HARPETH DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7511
Practice Address - Country:US
Practice Address - Phone:615-373-1012
Practice Address - Fax:615-373-3819
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TND.S. 50421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice