Provider Demographics
NPI:1689917619
Name:SULLIVAN, DANIEL YOUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:YOUNG
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 M ST NW
Mailing Address - Street 2:SUITE 610
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-1404
Mailing Address - Country:US
Mailing Address - Phone:202-466-3333
Mailing Address - Fax:
Practice Address - Street 1:2440 M ST NW
Practice Address - Street 2:SUITE 610
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1404
Practice Address - Country:US
Practice Address - Phone:202-466-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1000584122300000X
VA0401411634122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist