Healthcare Provider Details

I. General information

NPI: 1134034416
Provider Name (Legal Business Name): MARIE SULLIVAN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 ZANG ST
BROOMFIELD CO
80021-8223
US

IV. Provider business mailing address

520 ZANG ST
BROOMFIELD CO
80021-8223
US

V. Phone/Fax

Practice location:
  • Phone: 303-665-1281
  • Fax:
Mailing address:
  • Phone: 303-665-1281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH.002027611
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: