Organization
PEDIATRIC DENTRISTRY OF MANSFIELD,PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH C. SULLIVAN DDS, MS PC (OWNER)
(817) 473-7171
Entity
Organization
Contact information
Practice address
1830 E BROAD ST, STE104, MANSFIELD, TX 76063-9162
(817) 473-7171
(817) 473-2594
Mailing address
1830 E BROAD ST STE 104, MANSFIELD, TX 76063-9161
(817) 473-7171
(817) 473-2594
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
11/23/2011
Last updated
12/30/2014
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