MEDICARE: WILLIAM WALTER SULLIVAN DDS

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	122300000X	Dentist	1685	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	83825	OTHER	RI	BLUE CROSS BLUE SHIELD
2	1685	OTHER	RI	DELTA DENTAL

General Provider Information

NPI Number	:	1588614630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM WALTER SULLIVAN DDS

Provider Business Mailing Address
First Line	:	6810 POST RD
Second Line	:
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852
Country	:	US
Telephone Number	:	401-884-1525
Fax Number	:

Provider Business Practice Location Address
First Line	:	6810 POST RD
Second Line	:
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852
Country	:	US
Telephone Number	:	401-884-1525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	07/08/2007

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