Individual
DR. JOHN J SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
325 W WHITE MOUNTAIN BLVD, LAKESIDE, AZ 85929-6875
(928) 367-4276
(928) 367-1539
Mailing address
325 W WHITE MOUNTAIN BLVD, LAKESIDE, AZ 85929-6875
(928) 367-4276
(928) 367-1539
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2685
AZ
Other
Enumeration date
12/13/2006
Last updated
04/21/2010
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