Provider Demographics
NPI:1700157195
Name:SULLIVAN, ANNELISE HELEN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:ANNELISE
Middle Name:HELEN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8803 BRECKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-1932
Mailing Address - Country:US
Mailing Address - Phone:440-526-7506
Mailing Address - Fax:440-526-7546
Practice Address - Street 1:8803 BRECKSVILLE RD
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-1932
Practice Address - Country:US
Practice Address - Phone:440-526-7506
Practice Address - Fax:440-526-7546
Is Sole Proprietor?:No
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0231921223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics