Individual
DR. JOHN P. SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
60 TOBEY VILLAGE, PITTSFORD, NY 14534-1858
(585) 586-7170
Mailing address
105 NEUCHATEL LN, FAIRPORT, NY 14450-4634
(585) 586-7170
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
055771-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
055771-1
NYS DENTAL LICENSE
NY
Enumeration date
08/19/2005
Last updated
01/17/2012
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