Stephanie Sullivan Tullos, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

3265-03 Issued in MS

Practice address

276 Magnolia Dr
Raleigh, MS 39153-6016

Phone

(601) 782-9909

Fax

(601) 782-9133

NPI assigned

Mar 13, 2008

Last updated

Mar 13, 2008By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Networks

• LA PPO C-SNP

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Tullos Family Dentistry, PA

  • Dentist
  • Raleigh, MS
  • NPI 1467519827
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205366400000",
    "number": "1063683472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "276 MAGNOLIA DR",
            "city": "RALEIGH",
            "state": "MS",
            "postal_code": "391536016",
            "telephone_number": "601-782-9909",
            "fax_number": "601-782-9133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "276 MAGNOLIA DR",
            "city": "RALEIGH",
            "state": "MS",
            "postal_code": "391536016",
            "telephone_number": "601-782-9909",
            "fax_number": "601-782-9133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TULLOS",
        "first_name": "STEPHANIE",
        "middle_name": "SULLIVAN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-03-13",
        "last_updated": "2008-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MS",
            "license": "3265-03",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00077253",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Smith County LTC, LLC
• St Dominic Medical Associates LLC (St Dominic Raleigh Family Practice)
• Phil Thompson, DO
• Cassidy L Thornton, LICSW
• Tullos Family Dentistry, PA
• Kimberly Sharelle Watkins, FNP-C
• Vaniecia Wilson, DMD
• Alexandra Winn, NP

• Dentist in Raleigh, MS
• Providers in Raleigh, MS by specialty
• Dentist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2008; 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.

Verify at the official NPI Registry.