# MARK R SULLIVAN DDS

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

## Provider details

- **NPI number:** 1851461347
- **Authorized official:** MARK SULLIVAN (DENTIST)
- **Authorized official phone:** (586) 797-9118

## Contact information

- **Practice address:** 54951 MOUND ROAD, SHELBY TWP, MI 48316-6028
- **Practice address phone:** (586) 797-9118
- **Practice address fax:** (586) 797-9085
- **Mailing address:** 54951 MOUND ROAD, SHELBY TWP, MI 48316-6028
- **Mailing address phone:** (586) 797-9118
- **Mailing address fax:** (586) 797-9085

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12343 | MI | Yes |

## Other

- **Enumeration date:** 11/09/2006
- **Last updated:** 07/17/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4062594 | — | MI |