DR. Jackson Lee Sullivan, D.D.S., PA

NPI #1194733725 in Bradenton, Florida

Provider Information

NPI Number: 1194733725
Entity Type: Individual
Name: DR. Jackson Lee Sullivan, D.D.S., PA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist - Endodontics
Credential: D.D.S., PA
Enumeration Date: Aug 3, 2006
Last Updated: Mar 1, 2022

Practice Location

Address: 1906 59TH ST W STE D
City: Bradenton
State: Florida
ZIP Code: 34209-4639
Phone: (941) 840-1906

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - Endodontics — Endodontics	1223E0200X	Primary

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