MEDICARE: SULLIVAN-HOPKINSON DENTISTRY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry		IN

General Provider Information

NPI Number	:	1366982027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SULLIVAN-HOPKINSON DENTISTRY LLC

Provider Business Mailing Address
First Line	:	2495 TROTTERS CHASE
Second Line	:
City	:	SHELBYVILLE
State	:	IN
Zip	:	46176-8873
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14139 TOWN CENTER BLVD STE 200
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060-3368
Country	:	US
Telephone Number	:	317-773-9992
Fax Number	:

Authorized Official
Title or Position	:	DENTIST-PARTNER
Name	:	DR. MATTHEW T SULLIVAN
Credential	:	DDS
Telephone Number	:	317-797-4118

Provider Enumeration Date	:	02/28/2017
Last Update Date	:	02/28/2017

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