Provider Demographics
NPI:1982865986
Name:DR. JOHN V. SULLIVANT, D.D.S. P.A.
Entity Type:Organization
Organization Name:DR. JOHN V. SULLIVANT, D.D.S. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:VIRGIL
Authorized Official - Last Name:SULLIVANT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-425-4242
Mailing Address - Street 1:727 N CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-3253
Mailing Address - Country:US
Mailing Address - Phone:870-425-4242
Mailing Address - Fax:870-425-4243
Practice Address - Street 1:727 N CARDINAL DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3253
Practice Address - Country:US
Practice Address - Phone:870-425-4242
Practice Address - Fax:870-425-4243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR27881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty