Provider Demographics
NPI:1700889789
Name:SULLIVAN, STEVEN M
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:M
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N LINCOLN BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-3252
Mailing Address - Country:US
Mailing Address - Phone:405-271-4955
Mailing Address - Fax:405-271-4525
Practice Address - Street 1:1000 N LINCOLN BLVD
Practice Address - Street 2:STE 200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-3252
Practice Address - Country:US
Practice Address - Phone:405-271-4955
Practice Address - Fax:405-271-4525
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK50621223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery