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General NPI Number Information
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NPI Number | 1871693705
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Entity Type | Individual
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Provider Name | JENNIFER ANGELA SULLIVAN DMD, MS
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Gender | Female
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 10/22/2015
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Provider Practice Location Address
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Address Line | 3200 ANDREWS HWY SUITE 400
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City | MIDLAND
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State | TX
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Zip | 79701-3896
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Country | US
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Telephone | 432-218-7926
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 ANDREWS HWY SUITE 400
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City | MIDLAND
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State | TX
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Zip | 79701-3896
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Country | US
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Telephone | 432-218-7926
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 31170
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 8160
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 12011561A
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License Number State | IN
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