| Sullivan Family Dentistry, Llc | |
|
2186 N Hospital Blvd., Suite 1 Sullivan IN 47882-0468 | |
| (812) 268-4010 | |
| (812) 268-5607 |
| Full Name | Sullivan Family Dentistry, Llc |
|---|---|
| Speciality | Dentist |
| Location | 2186 N Hospital Blvd., Suite 1, Sullivan, Indiana |
| Authorized Official Name and Position | Gregg W Smith (SENIOR PARTNER OWNER) |
| Authorized Official Contact | 8122684010 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sullivan Family Dentistry, Llc Po Box 468 Sullivan IN 47882-0468 Ph: (812) 268-4010 | Sullivan Family Dentistry, Llc 2186 N Hospital Blvd., Suite 1 Sullivan IN 47882-0468 Ph: (812) 268-4010 |
| NPI Number | 1871996199 |
|---|---|
| Provider Enumeration Date | 10/01/2014 |
| Last Update Date | 01/08/2020 |
| Medicare PECOS PAC ID | 8325477029 |
|---|---|
| Medicare Enrollment ID | O20200401000356 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871996199 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 12007736A (Indiana) | Secondary |
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |