Organization
TRINITY RIVER DENTAL PROFESSIONAL CORPORATION
Active
Other names
Northern California Dental Sleep Therapy Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PREDDIS LEROY SULLIVAN DDS (PRESIDENT)
(916) 517-9905
Entity
Organization
Contact information
Practice address
1619 N WATERFRONT PKWY, WICHITA, KS 67206-6602
(916) 517-9905
Mailing address
3620 N CREST CT, WICHITA, KS 67226-1019
(916) 517-9905
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
54500
CA
Other
Enumeration date
08/23/2010
Last updated
10/06/2022
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