Provider Demographics
NPI:1609299163
Name:SULLIVAN, MARGOT C (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARGOT
Middle Name:C
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2599 WADSWORTH BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-5640
Mailing Address - Country:US
Mailing Address - Phone:303-421-4820
Mailing Address - Fax:303-421-4820
Practice Address - Street 1:2599 WADSWORTH BLVD STE 3
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-5640
Practice Address - Country:US
Practice Address - Phone:303-421-4820
Practice Address - Fax:303-421-4820
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7792122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist