Provider Demographics
NPI:1194995720
Name:SULLIVAN, WILLIAM NICHOLAS
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:NICHOLAS
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 1:6100 TRAIL BLVD NORTH
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108
Mailing Address - Country:US
Mailing Address - Phone:239-597-4944
Mailing Address - Fax:239-514-0455
Practice Address - Street 1:6100 TRAIL BLVD NORTH
Practice Address - Street 2:SUITE 1
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108
Practice Address - Country:US
Practice Address - Phone:239-597-4944
Practice Address - Fax:239-514-0455
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 14951122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist