Provider Demographics
NPI:1316144496
Name:PATRICIA A SULLIVAN, DMD,PA
Entity type:Organization
Organization Name:PATRICIA A SULLIVAN, DMD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-372-3600
Mailing Address - Street 1:3720 NW 43RD ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6190
Mailing Address - Country:US
Mailing Address - Phone:352-372-3600
Mailing Address - Fax:352-374-8933
Practice Address - Street 1:3720 NW 43RD ST
Practice Address - Street 2:SUITE 102
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6190
Practice Address - Country:US
Practice Address - Phone:352-372-3600
Practice Address - Fax:352-374-8933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN10647261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental