Provider Demographics
NPI:1477659167
Name:SULLIVAN, GRACIELA KUATA (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:GRACIELA
Middle Name:KUATA
Last Name:SULLIVAN
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Gender:F
Credentials:DDS, MS
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Mailing Address - Street 1:5112 WARNER AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-6036
Mailing Address - Country:US
Mailing Address - Phone:714-377-2628
Mailing Address - Fax:714-377-0090
Practice Address - Street 1:5112 WARNER AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-6036
Practice Address - Country:US
Practice Address - Phone:714-377-2628
Practice Address - Fax:714-377-0090
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CA505351223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry