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General NPI Number Information
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NPI Number | 1487668844
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Entity Type | Individual
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Provider Name | ROBERT LAWRENCE SULLIVAN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 40 CHURCH ST
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City | WARE
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State | MA
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Zip | 01082-1234
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Country | US
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Telephone | 413-967-5833
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Fax | 413-967-5933
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Provider Business Mailing Address
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Address Line | 211 IDUNA LN
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City | AMHERST
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State | MA
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Zip | 01002-3424
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Country | US
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Telephone | 413-256-6116
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | MA10928
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License Number State | MA
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