Provider Demographics
NPI:1114031754
Name:SULLIVAN, ALIYA R (DDS)
Entity type:Individual
Prefix:DR
First Name:ALIYA
Middle Name:R
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ALIYA
Other - Middle Name:R
Other - Last Name:ELMAJRI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7600 SUNWOOD DR NW
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-5293
Mailing Address - Country:US
Mailing Address - Phone:763-203-6040
Mailing Address - Fax:
Practice Address - Street 1:7600 SUNWOOD DR NW
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303-5293
Practice Address - Country:US
Practice Address - Phone:763-203-6040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12234122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist