Provider Demographics
NPI:1972848919
Name:SULLIVAN, JEANNE F (RDH)
Entity Type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:F
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-3723
Mailing Address - Country:US
Mailing Address - Phone:508-951-6403
Mailing Address - Fax:
Practice Address - Street 1:97 CHURCH ST
Practice Address - Street 2:
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719-3723
Practice Address - Country:US
Practice Address - Phone:508-951-6403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADH10483124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist