Healthcare Provider Details

I. General information

NPI: 1023201209
Provider Name (Legal Business Name): FRANK VINIC SULLIVAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5436 COMMERCE
SAINT FRANCISVILLE LA
70775-2880
US

IV. Provider business mailing address

PO BOX 2880 5436 COMMERCE ST
SAINT FRANCISVILLE LA
70775-2880
US

V. Phone/Fax

Practice location:
  • Phone: 225-635-4422
  • Fax: 225-635-2171
Mailing address:
  • Phone: 225-635-4422
  • Fax: 225-635-2171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5062
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: