Provider Demographics
NPI:1649956152
Name:SULLIVAN, BRITTNEY (DDS)
Entity type:Individual
Prefix:DR
First Name:BRITTNEY
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 DETROIT AVE APT 218
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-2767
Mailing Address - Country:US
Mailing Address - Phone:937-620-5855
Mailing Address - Fax:
Practice Address - Street 1:3045 SMITH RD STE 100
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-4449
Practice Address - Country:US
Practice Address - Phone:937-620-5855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.027281122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist