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General NPI Number Information
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NPI Number | 1578765368
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Entity Type | Organization
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Legal Business Name | THAD A. SULLENS, D.M.D., PC
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 07/26/2007
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Provider Practice Location Address
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Address Line | 7040 GADSDEN HWY STE 112
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City | TRUSSVILLE
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State | AL
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Zip | 35173-2680
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Country | US
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Telephone | 205-655-5219
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Fax |
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Provider Business Mailing Address
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Address Line | 7040 GADSDEN HWY STE 112
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City | TRUSSVILLE
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State | AL
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Zip | 35173-2680
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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 | DR. THAD SULLENS
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Credential | D.M.D.
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Telephone | 205-655-5219
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5163
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License Number State | AL
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