Provider Demographics
NPI:1649376468
Name:SULLIVAN, DANIEL PETER (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:PETER
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:PETER
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:58 MOUNT BETHEL RD
Mailing Address - Street 2:STE 202
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-2654
Mailing Address - Country:US
Mailing Address - Phone:908-222-7922
Mailing Address - Fax:908-222-7923
Practice Address - Street 1:58 MOUNT BETHEL RD
Practice Address - Street 2:STE 202
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-2654
Practice Address - Country:US
Practice Address - Phone:908-222-7922
Practice Address - Fax:908-222-7923
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI020367001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery