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General NPI Number Information
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NPI Number | 1982865986
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Entity Type | Organization
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Legal Business Name | DR. JOHN V. SULLIVANT, D.D.S. P.A.
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Dates
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Enumeration Date | 06/23/2008
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 727 N CARDINAL DR
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City | MOUNTAIN HOME
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State | AR
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Zip | 72653-3253
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Country | US
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Telephone | 870-425-4242
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Fax | 870-425-4243
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Provider Business Mailing Address
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Address Line | 727 N CARDINAL DR
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City | MOUNTAIN HOME
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State | AR
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Zip | 72653-3253
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Country | US
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Telephone | 870-425-4242
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Fax | 870-425-4243
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. JOHN VIRGIL SULLIVANT
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Credential | DDS
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Telephone | 870-425-4242
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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 | AR2788
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License Number State | AR
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