Provider Demographics
NPI:1811623994
Name:SULLIVAN, JOSHUA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
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 1:5601 18TH ST UNIT 55
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-2985
Mailing Address - Country:US
Mailing Address - Phone:970-310-7738
Mailing Address - Fax:
Practice Address - Street 1:2310 CRAVEN ST, BLDG 3230
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92136
Practice Address - Country:US
Practice Address - Phone:619-556-9151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12955995-9921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist