Provider Demographics
NPI:1801819974
Name:SULLIVAN, TERENCE C (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:TERENCE
Middle Name:C
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15224 MAIN ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-7316
Mailing Address - Country:US
Mailing Address - Phone:425-385-2641
Mailing Address - Fax:425-385-2644
Practice Address - Street 1:15224 MAIN ST
Practice Address - Street 2:SUITE 302
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-7316
Practice Address - Country:US
Practice Address - Phone:425-385-2641
Practice Address - Fax:425-385-2644
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000069111223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics