Provider Demographics
NPI:1932124690
Name:SULLIVAN, THOMAS KEVIN (DMD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:KEVIN
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086
Mailing Address - Country:US
Mailing Address - Phone:207-729-2740
Mailing Address - Fax:207-729-2717
Practice Address - Street 1:3 MAIN ST
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086
Practice Address - Country:US
Practice Address - Phone:207-729-2740
Practice Address - Fax:207-729-2717
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME29651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics