Individual
MATILDA DAUS SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1352 SOUTH ST # C5, PHILADELPHIA, PA 19147-1858
(267) 909-9551
Mailing address
2011 BAINBRIDGE ST APT 2, PHILADELPHIA, PA 19146-1308
(434) 610-7021
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DS044472
PA
Other
Enumeration date
02/28/2022
Last updated
08/27/2024
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