Provider Demographics
NPI:1558031013
Name:SULLIVAN SURGICAL ARTS
Entity Type:Organization
Organization Name:SULLIVAN SURGICAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER-DENIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:IV
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-373-1012
Mailing Address - Street 1:5015 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:615-373-3819
Practice Address - Street 1:5015 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental