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Individual
BRETT MICHAEL SULLIVAN
Active
Individual
BRETT MICHAEL SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D., M.D.
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2007019263
MO
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D9737
OR
Other
Enumeration date
08/01/2007
Last updated
12/06/2024
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