MEDICARE: DR. ANDREW J SULLIVAN DDS, MSD

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	1223E0200X	Endodontics	12013628A	IN

General Provider Information

NPI Number	:	1912573023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW J SULLIVAN DDS, MSD

Provider Business Mailing Address
First Line	:	2320 NORTHPARK DR STE C
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-4482
Country	:	US
Telephone Number	:	317-604-6787
Fax Number	:

Provider Business Practice Location Address
First Line	:	2320 NORTHPARK DR STE C
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-4482
Country	:	US
Telephone Number	:	812-552-2320
Fax Number	:

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

Provider Enumeration Date	:	05/29/2021
Last Update Date	:	04/15/2026

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