Individual
DR. LAURA GRACE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1949 CR 210 W, SAINT JOHNS, FL 32259-2062
(904) 402-4409
(904) 342-8113
Mailing address
1949 CR 210 W, SAINT JOHNS, FL 32259
(904) 808-4700
(904) 342-8113
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN18660
FL
1223P0221X
Pediatric Dentistry
Primary
DN18660
FL
Other
Enumeration date
07/10/2009
Last updated
08/02/2013
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