Provider Demographics
NPI:1528196367
Name:SULTANOV, DAVID (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:SULTANOV
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 S BRADDOCK AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15218-1262
Mailing Address - Country:US
Mailing Address - Phone:412-242-5800
Mailing Address - Fax:412-242-3320
Practice Address - Street 1:1112 S BRADDOCK AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15218-1262
Practice Address - Country:US
Practice Address - Phone:412-242-5800
Practice Address - Fax:412-242-3320
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023064L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice