Healthcare Provider Details

I. General information

NPI: 1174437891
Provider Name (Legal Business Name): RYAN P OSULLIVAN DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1998 N COLLEGE AVE
FAYETTEVILLE AR
72703-2609
US

IV. Provider business mailing address

1998 N COLLEGE AVE
FAYETTEVILLE AR
72703-2609
US

V. Phone/Fax

Practice location:
  • Phone: 479-222-1118
  • Fax:
Mailing address:
  • Phone: 479-222-1118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: RYAN O'SULLIVAN
Title or Position: OWNER
Credential: D.D.S. MS
Phone: 918-232-0395