Individual
DR. JENNIFER ANGELA SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD, MS
Contact information
Practice address
3200 ANDREWS HWY, SUITE 400, MIDLAND, TX 79701-3896
(432) 218-7926
Mailing address
3200 ANDREWS HWY, SUITE 400, MIDLAND, TX 79701-3896
(432) 218-7926
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
12011561A
IN
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
31170
TX
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
8160
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60003134
—
KY
05
—
9177836
—
KY
Enumeration date
09/22/2006
Last updated
10/22/2015
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