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General NPI Number Information
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NPI Number | 1649457300
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Entity Type | Individual
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Provider Name | MICHAEL ANTHONY SULLIVAN DDS
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Gender | Male
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Dates
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Enumeration Date | 01/24/2008
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 233 N SPRINGBORO PIKE
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City | DAYTON
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State | OH
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Zip | 45449-3641
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Country | US
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Telephone | 937-428-6590
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Fax |
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Provider Business Mailing Address
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Address Line | 5130 MICHAEL ANTHONY LN
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City | CINCINNATI
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State | OH
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Zip | 45247-7944
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Country | US
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Telephone | 231-675-9570
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 30.022906
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901019909
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License Number State | MI
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