Organization
SULLIVAN DENTISTRY,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN S SULLIVAN DDS (OWNER)
(262) 642-2296
Entity
Organization
Contact information
Practice address
920 GREENWALD CT, STE 300, MUKWONAGO, WI 53149-1711
(262) 642-2296
Mailing address
N9225 S SHORE DR, EAST TROY, WI 53120-2178
(262) 642-2296
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5098-015
WI
Other
Enumeration date
08/24/2007
Last updated
08/24/2007
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