Provider Demographics
NPI:1679860068
Name:SULLIVAN, MARGARETANNE HARTMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARGARETANNE
Middle Name:HARTMAN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARGARET
Other - Middle Name:ANNE
Other - Last Name:HARTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:307 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-3315
Mailing Address - Country:US
Mailing Address - Phone:509-962-9020
Mailing Address - Fax:509-925-9022
Practice Address - Street 1:307 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3315
Practice Address - Country:US
Practice Address - Phone:509-962-9020
Practice Address - Fax:509-925-9022
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA83061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice