Active NPI
Daren T Sullivan, DDS
- General Practice Dentistry
- Fargo, ND
National Provider Identifier
1063649671
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2056
- Practice address
- 1231 27TH St S Ste C
Fargo, ND 58103-8722 - Phone
- (701) 232-6983
- Fax
- (701) 239-9375
- NPI assigned
- Jun 22, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2056 | ND | Primary |
Addresses
Primary practice location
1231 27TH St S Ste C
Fargo, ND 58103-8722
Mailing address
1231 27TH St S Ste C
Fargo, ND 58103-8722
Phone (701) 232-6983
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 41504 | Medicaid | ND | |
| 1457270 | Medicaid | ND |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ND
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160706002262 | ND | Order and Referring Only - Oral Surgery | 2860784147 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tronsgard and Sullivan DDS Partnership | General Practice | Current | Accepting new patients |
Locations
1231 27th St S
Ste C
Fargo, ND 58103
Phone (701) 232-6983
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1463443200000",
"number": "1063649671",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1231 27TH ST S STE C",
"city": "FARGO",
"state": "ND",
"postal_code": "581038722",
"telephone_number": "701-232-6983",
"fax_number": "701-239-9375"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1231 27TH ST S STE C",
"city": "FARGO",
"state": "ND",
"postal_code": "581038722",
"telephone_number": "701-232-6983",
"fax_number": "701-239-9375"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "DAREN",
"middle_name": "T",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-06-22",
"last_updated": "2016-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "ND",
"license": "2056",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "41504",
"state": "ND"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1457270",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.