MS. Maenell Sullivan, DENTURIST DPD

NPI #1679675367 in Tenino, Washington

Provider Information

NPI Number: 1679675367
Entity Type: Individual
Name: MS. Maenell Sullivan, DENTURIST DPD
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Denturist
Credential: DENTURIST DPD
Enumeration Date: Sep 2, 2006
Last Updated: Jul 8, 2007

Practice Location

Address: 296 SUSSEX AVE W
City: Tenino
State: Washington
ZIP Code: 98589
Phone: (360) 264-5500

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Denturist	122400000X	Primary

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