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General NPI Number Information
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NPI Number | 1508085713
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Entity Type | Organization
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Legal Business Name | T. KEVIN SULLIVAN, DMD LLC
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3 MAIN ST
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City | TOPSHAM
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State | ME
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Zip | 04086-1216
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Country | US
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Telephone | 207-729-2740
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Fax |
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Provider Business Mailing Address
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Address Line | 3 MAIN ST
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City | TOPSHAM
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State | ME
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Zip | 04086-1216
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Country | US
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Telephone | 207-729-2740
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN SULLIVAN
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Credential | DMD
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Telephone | 207-729-2740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2965
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License Number State | ME
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