Provider Demographics
NPI:1841676855
Name:SULLIVAN, SARA (DDS)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:15 ENGLE ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2936
Mailing Address - Country:US
Mailing Address - Phone:201-308-8181
Mailing Address - Fax:201-875-5588
Practice Address - Street 1:3097 STEINWAY ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3440
Practice Address - Country:US
Practice Address - Phone:718-545-5100
Practice Address - Fax:888-292-7017
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY0579131223X0400X
NJ026029001223X0400X
CT113911223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics