Individual
MARTHA M SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
GENERAL DENTISTRY
Contact information
Practice address
26 QUEEN ST, DENTAL, WORCESTER, MA 01610-2473
(508) 860-7700
(508) 860-7990
Mailing address
26 QUEEN ST, DENTAL, WORCESTER, MA 01610-2473
(508) 860-7700
(508) 860-7990
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
15920
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1300709
—
MA
01
—
15920
ANTHEM BCBS DENTAL
MA
01
—
91285
FALLON SELECT
MA
01
—
AA20303
HARVARD PILGRIM
MA
Enumeration date
08/10/2006
Last updated
07/09/2007
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