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General NPI Number Information
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NPI Number | 1649442252
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Entity Type | Organization
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Legal Business Name | JERRY E. SULLINS, DDS
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Dates
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Enumeration Date | 03/24/2008
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Last Update Date | 03/24/2008
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Provider Practice Location Address
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Address Line | 104 HAZEL PATH SUITE 1
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-3844
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Country | US
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Telephone | 615-824-7220
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Fax | 615-824-9947
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Provider Business Mailing Address
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Address Line | 104 HAZEL PATH SUITE 1
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-3844
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Country | US
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Telephone | 615-824-7220
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Fax | 615-824-9947
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Authorized Official
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Title or Position | FRONT OFFICE MANAGER
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Name | DAPHNE POTTER
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Credential |
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Telephone | 615-824-7220
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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 | DS3056
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License Number State | TN
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