Provider Demographics
NPI:1972649143
Name:SULLIVAN, DEBORAH C (DDS)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:C
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 U.S. HWY 287
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063
Mailing Address - Country:US
Mailing Address - Phone:817-473-7171
Mailing Address - Fax:817-473-2594
Practice Address - Street 1:1200 U.S. HWY 287 NORTH
Practice Address - Street 2:SUITE 102
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063
Practice Address - Country:US
Practice Address - Phone:817-473-7171
Practice Address - Fax:817-473-2594
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX192461223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry