Healthcare Provider Details

I. General information

NPI: 1679522130
Provider Name (Legal Business Name): ASHLEY H. SULLIVAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 ASHEVILLE HWY
KNOXVILLE TN
37914-4252
US

IV. Provider business mailing address

5316 SUNSET RD
KNOXVILLE TN
37914-4304
US

V. Phone/Fax

Practice location:
  • Phone: 865-525-6995
  • Fax: 865-525-5085
Mailing address:
  • Phone: 865-525-6995
  • Fax: 865-525-5085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS0000004035
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: