Individual
DR. STEPHANIE SULLIVAN TULLOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
276 MAGNOLIA DR, RALEIGH, MS 39153-6016
(601) 782-9909
(601) 782-9133
Mailing address
276 MAGNOLIA DR, RALEIGH, MS 39153-6016
(601) 782-9909
(601) 782-9133
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3265-03
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00077253
—
MS
Enumeration date
03/13/2008
Last updated
03/13/2008
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