Healthcare Provider Details

I. General information

NPI: 1447373048
Provider Name (Legal Business Name): STEPHEN ADAMS SULLIVAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 W. HWY. 11
WHITEWRIGHT TX
75491-0788
US

IV. Provider business mailing address

1218 W. HWY. 11
WHITEWRIGHT TX
75491-0788
US

V. Phone/Fax

Practice location:
  • Phone: 903-364-2958
  • Fax: 903-364-2958
Mailing address:
  • Phone: 903-364-2958
  • Fax: 903-364-2958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number7983
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: