Provider Demographics
NPI:1255171104
Name:ROUPAS SULLIVAN TREMONT PLLC-2
Entity type:Organization
Organization Name:ROUPAS SULLIVAN TREMONT PLLC-2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:PLYLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-568-8010
Mailing Address - Street 1:5833 PHYLISS LN
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-9031
Mailing Address - Country:US
Mailing Address - Phone:704-568-8010
Mailing Address - Fax:
Practice Address - Street 1:14746 LANCASTER HWY # B
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134-9313
Practice Address - Country:US
Practice Address - Phone:704-583-5217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty