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General NPI Number Information
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NPI Number | 1164315941
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Entity Type | Individual
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Provider Name | MADELINE SULLIVAN DMD
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Gender | Female
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Dates
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Enumeration Date | 05/31/2025
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Last Update Date | 01/03/2026
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Provider Practice Location Address
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Address Line | 1001 SHADOW LN
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City | LAS VEGAS
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State | NV
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Zip | 89106-4124
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Country | US
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Telephone | 702-774-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 9110 W TROPICANA AVE UNIT 289
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City | LAS VEGAS
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State | NV
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Zip | 89147-8254
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Country | US
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Telephone | 916-990-3111
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 8188
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License Number State | NV
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