Individual
BRETT MICHAEL SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D., M.D.
Contact information
Practice address
11211 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-7787
(503) 652-8080
(503) 526-8992
Mailing address
11211 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-7787
(503) 652-8080
(503) 289-9621
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2007019263
MO
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D9737
OR
Other
Enumeration date
08/01/2007
Last updated
12/06/2024
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