Individual
COLEEN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
400 HUALANI ST, BLDG 9 SUITE 192, HILO, HI 96720-4378
(808) 935-6620
(808) 935-6781
Mailing address
400 HUALANI ST, BLDG 9 SUITE 192, HILO, HI 96720-4378
(808) 935-6620
(808) 523-3121
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
4503
AZ
1223G0001X
General Practice Dentistry
Primary
DT-2596
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
191958
—
AZ
Enumeration date
09/09/2005
Last updated
12/19/2016
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