Individual
DR. DAVID J SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
525 E 68TH ST # F-2132, NEW YORK, NY 10065-4870
(212) 746-5115
Mailing address
N9225 S SHORE DR, EAST TROY, WI 53120-2178
(262) 366-4646
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1002777-15
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/20/2021
Last updated
06/09/2022
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