Provider Demographics
NPI:1740376037
Name:MARGOT C. SULLIVAN, DDS, PC
Entity type:Organization
Organization Name:MARGOT C. SULLIVAN, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGOT
Authorized Official - Middle Name:CARYN
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-421-4820
Mailing Address - Street 1:2599 WADSWORTH BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214
Mailing Address - Country:US
Mailing Address - Phone:303-421-4820
Mailing Address - Fax:303-421-4822
Practice Address - Street 1:2599 WADSWORTH BLVD,
Practice Address - Street 2:SUITE 3
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214
Practice Address - Country:US
Practice Address - Phone:303-421-4820
Practice Address - Fax:303-421-4822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7792122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty