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General NPI Number Information
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NPI Number | 1053893024
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Entity Type | Organization
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Legal Business Name | SULLIVAN FAMILY DENTISTRY, PLLC
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Dates
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Enumeration Date | 09/05/2018
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Last Update Date | 10/03/2018
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Provider Practice Location Address
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Address Line | 2000 RICHARD JONES RD STE 107
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City | NASHVILLE
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State | TN
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Zip | 37215-2885
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Country | US
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Telephone | 615-298-1651
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Fax | 615-298-1129
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Provider Business Mailing Address
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Address Line | 2000 RICHARD JONES RD STE 107
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City | NASHVILLE
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State | TN
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Zip | 37215-2885
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Country | US
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Telephone | 615-298-1651
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Fax | 615-298-1129
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Authorized Official
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Title or Position | DENTIST
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Name | HUNTER C. FLEENOR
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Credential | DDS
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Telephone | 615-298-1651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10515
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License Number State | TN
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