Individual
DR. JACKSON LEE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., PA
Contact information
Practice address
1906 59TH ST W STE D, BRADENTON, FL 34209-4639
(941) 840-1906
(941) 840-1906
Mailing address
1906 59TH ST W STE D, BRADENTON, FL 34209-4639
(941) 840-1906
(941) 840-1906
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
DN15529
FL
Other
Enumeration date
08/03/2006
Last updated
03/01/2022
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