Provider Demographics
NPI:1255544912
Name:JOHN F SULLIVAN DDS & PATRICK M GORMAN DDS LTD
Entity type:Organization
Organization Name:JOHN F SULLIVAN DDS & PATRICK M GORMAN DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-331-1900
Mailing Address - Street 1:615 EAST 162ND STREET
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-2389
Mailing Address - Country:US
Mailing Address - Phone:708-331-1900
Mailing Address - Fax:708-331-1248
Practice Address - Street 1:615 EAST 162ND STREET
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-2389
Practice Address - Country:US
Practice Address - Phone:708-331-1900
Practice Address - Fax:708-331-1248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019A12318122300000X
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty