MEDICARE: DR. STEVEN M SULLIVAN

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	5062	OK

General Provider Information

NPI Number	:	1700889789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN M SULLIVAN

Provider Business Mailing Address
First Line	:	1000 N LINCOLN BLVD
Second Line	:	STE 200
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-3252
Country	:	US
Telephone Number	:	405-271-4955
Fax Number	:	405-271-4525

Provider Business Practice Location Address
First Line	:	1000 N LINCOLN BLVD
Second Line	:	STE 200
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-3252
Country	:	US
Telephone Number	:	405-271-4955
Fax Number	:	405-271-4525

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/08/2007

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