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General NPI Number Information
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NPI Number | 1376431346
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Entity Type | Organization
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Legal Business Name | MATTHIEU SULLIVAN DDS CORP
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Dates
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Enumeration Date | 06/26/2025
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 8540 S SEPULVEDA BLVD STE 800
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City | LOS ANGELES
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State | CA
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Zip | 90045-3828
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Country | US
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Telephone | 310-670-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 3917 VIA SOLANO
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City | PALOS VERDES ESTATES
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State | CA
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Zip | 90274-1127
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MATTHIEU SULLIVAN
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Credential | DDS
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Telephone | 918-850-1850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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