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General NPI Number Information
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NPI Number | 1487950499
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Entity Type | Organization
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Legal Business Name | R.L. SULLIVAN, D.D.S. INC.
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Dates
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Enumeration Date | 02/09/2011
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Last Update Date | 02/09/2011
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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 | 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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Authorized Official
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Title or Position | ORAL & MAXILLOFACIAL SURGEON
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Name | DR. ROBERT LAWRENCE SULLIVAN
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Credential | D.D.S.
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Telephone | 413-967-5833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | 10928
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License Number State | MA
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