MEDICARE: DANIEL T. SULLIVAN D.D.S.

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	12242	MO

General Provider Information

NPI Number	:	1942338777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL T. SULLIVAN D.D.S.

Provider Business Mailing Address
First Line	:	7247 DELMAR BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-4105
Country	:	US
Telephone Number	:	314-727-1319
Fax Number	:	314-727-7221

Provider Business Practice Location Address
First Line	:	7247 DELMAR BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-4105
Country	:	US
Telephone Number	:	314-727-1319
Fax Number	:	314-727-7221

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

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	07/08/2007

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