Organization
JACKSON L. SULLIVAN D.D.S., P.C.
Active
Parent organization
JACKSON L. SULLIVAN D.D.S., P.C.
Other names
Edmond Endodontics
Organization subpart
Yes
Provider details
NPI number
Legal business name
JACKSON L. SULLIVAN D.D.S., P.C.
Authorized official
DR. JACKSON L SULLIVAN DDS (DOCTOR)
(405) 844-8444
Entity
Organization
Contact information
Practice address
609 S KELLY AVE STE E1, EDMOND, OK 73003-7501
(405) 844-8444
(405) 844-8440
Mailing address
609 S KELLY AVE STE E1, EDMOND, OK 73003-7501
(405) 844-8444
(405) 844-8440
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
5244
OK
Other
Enumeration date
04/20/2007
Last updated
06/12/2008
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