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General NPI Number Information
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NPI Number | 1174932511
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Entity Type | Individual
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Provider Name | VICTORIA KARRYN SULLIVAN DDS
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Gender | Female
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Dates
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Enumeration Date | 08/11/2014
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Last Update Date | 07/31/2020
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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 | 702-774-2416
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Fax |
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Provider Business Mailing 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 | 702-774-2682
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 42679
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 33661
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 42679
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | S6-182C
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License Number State | NV
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