Jerry L Sullivan, DDS

NPI #1093929044 in Kingman, Arizona

Provider Information

NPI Number
1093929044
Entity Type
Individual
Name
Jerry L Sullivan, DDS
Gender
Not Specified
Sole Proprietor
Yes
Primary Specialty
Dentist - General Practice
Credential
DDS
Enumeration Date
May 9, 2007
Last Updated
Jul 8, 2007

Practice Location

Address
411 GRANDVIEW AVE
State
Arizona
ZIP Code
86401-5745
Phone
(928) 753-6611

Specialties & Taxonomy Codes

Specialty
Dentist - General PracticeGeneral Practice

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