Individual
DR. MARK ROBERT SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
54951 MOUND RD, SHELBY TOWNSHIP, MI 48316-6028
(586) 797-9118
(586) 797-9085
Mailing address
55191 SHELBY RD, SHELBY TOWNSHIP, MI 48316-1150
(586) 797-9118
(586) 797-9085
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12343
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4062594
—
MI
Enumeration date
07/20/2007
Last updated
05/25/2016
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