MEDICARE: DR. VICTORIA KARRYN SULLIVAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	33661	TX
2	122300000X	Dentist	42679	CA
3	1223P0221X	Pediatric Dentistry	7751	LA
4	1223P0221X	Pediatric Dentistry	42679	CA
5	1223P0221X	Pediatric Dentistry	S6-182C	NV

General Provider Information

NPI Number	:	1174932511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTORIA KARRYN SULLIVAN DDS

Provider Business Mailing Address
First Line	:	1100 FLORIDA AVE # 19
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-2715
Country	:	US
Telephone Number	:	504-941-8250
Fax Number	:	504-941-8200

Provider Business Practice Location Address
First Line	:	1100 FLORIDA AVE # 19
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-2715
Country	:	US
Telephone Number	:	504-941-8250
Fax Number	:	504-941-8200

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2014
Last Update Date	:	05/28/2026

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