# BEACON DENTAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205205267
- **Authorized official:** DR. MICHAEL A SULLIVAN DDS (OWNER / DOCTOR)
- **Authorized official phone:** (231) 547-9141

## Contact information

- **Practice address:** 6483 M 66 N, CHARLEVOIX, MI 49720-9272
- **Practice address phone:** (231) 547-9141
- **Practice address fax:** (231) 547-5077
- **Mailing address:** 6483 M 66 N, CHARLEVOIX, MI 49720-9272
- **Mailing address phone:** (231) 547-9141

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 13522 | MI | — |
| 1223G0001X | General Practice Dentistry | 19909 | MI | Yes |

## Other

- **Enumeration date:** 09/21/2015
- **Last updated:** 09/21/2015