Individual
ELIZABETH SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
63 PREBLE ST, PORTLAND, ME 04101-3014
(207) 874-2141
(207) 874-2164
Mailing address
180 PARK AVE STE 1, PORTLAND, ME 04102-2927
(207) 874-2141
(207) 874-2164
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
RDH4393
ME
Other
Enumeration date
10/29/2021
Last updated
10/29/2021
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