Provider Demographics
NPI:1588776967
Name:OSULLIVAN, SARAH K (DMD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:K
Last Name:OSULLIVAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 S GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17401-2773
Mailing Address - Country:US
Mailing Address - Phone:717-773-0408
Mailing Address - Fax:
Practice Address - Street 1:246 W GIRARD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-1776
Practice Address - Country:US
Practice Address - Phone:267-202-0083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031255122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABD1032483OtherDEA