Individual
ALYSSA SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1000 TRANSIT WAY, BROCKPORT, NY 14420-3008
(585) 636-0555
Mailing address
1000 TRANSIT WAY, BROCKPORT, NY 14420-3008
(585) 636-0555
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
061188
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/08/2019
Last updated
01/09/2021
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