MEDICARE: JOHN E. SULLIVAN, D.D.S. P.C.

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1598914111
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN E. SULLIVAN, D.D.S. P.C.

Provider Business Mailing Address
First Line	:	341 E GENEVA RD
Second Line	:
City	:	CAROL STREAM
State	:	IL
Zip	:	60188-2438
Country	:	US
Telephone Number	:	630-665-7350
Fax Number	:	630-665-0004

Provider Business Practice Location Address
First Line	:	341 E GENEVA RD
Second Line	:
City	:	CAROL STREAM
State	:	IL
Zip	:	60188-2438
Country	:	US
Telephone Number	:	630-665-7350
Fax Number	:	630-665-0004

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. RITA CODY
Credential	:
Telephone Number	:	630-665-7350

Provider Enumeration Date	:	09/18/2008
Last Update Date	:	09/18/2008

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