Provider Demographics
NPI:1902897549
Name:SULLIVAN, PATRICIA LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:LYNN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 ANDERSONVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-6755
Mailing Address - Country:US
Mailing Address - Phone:865-494-2740
Mailing Address - Fax:
Practice Address - Street 1:2717 ANDERSONVILLE HWY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-6755
Practice Address - Country:US
Practice Address - Phone:865-494-5274
Practice Address - Fax:865-494-5275
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0000007236122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist