Healthcare Provider Details

I. General information

NPI: 1033276837
Provider Name (Legal Business Name): DAVID MICHAEL SULLIVAN D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5177 N BEND RD
CINCINNATI OH
45211-1900
US

IV. Provider business mailing address

5177 N BEND RD
CINCINNATI OH
45211-1900
US

V. Phone/Fax

Practice location:
  • Phone: 513-662-5203
  • Fax: 513-662-5518
Mailing address:
  • Phone: 513-662-5203
  • Fax: 513-662-5518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number16545
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: