Provider Demographics
NPI:1508302167
Name:SULLIVAN DENTAL PARTNERS PLLC
Entity Type:Organization
Organization Name:SULLIVAN DENTAL PARTNERS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:HUGH
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:615-373-1012
Mailing Address - Street 1:5023 HARPETH DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7511
Mailing Address - Country:US
Mailing Address - Phone:615-373-1012
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5042122300000X
TN10036122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty