Active NPI
Joseph Vincent Sullivan, D.D.S.
- Dentist
- Omaha, NE
National Provider Identifier
1104107903
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 7685
- Practice address
- 2109 Cuming St
Omaha, NE 68102-4325 - Phone
- (406) 250-7093
- Fax
- (406) 250-7093
- NPI assigned
- Sep 7, 2011
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DE60232759 | WA | |
| Dentist | 122300000X | 7685 | NE | Primary |
Addresses
Primary practice location
2109 Cuming St
Omaha, NE 68102-4325
Mailing address
2109 Cuming St
Omaha, NE 68102-4325
Phone (402) 280-5990
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE60232759 | WA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Reggie Orozco DDS PLLC | General Practice | Past | Accepting new patients |
| Spencer S. Jilek, DDS | Dentist | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- General Practice Dentistry
- Pasco, WA
- NPI 1093428195
-
- Dentist
- Pasco, WA
- NPI 1053678102
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695254400000",
"number": "1104107903",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2109 CUMING ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681024325",
"telephone_number": "402-280-5990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2109 CUMING ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681024325",
"telephone_number": "406-250-7093",
"fax_number": "406-250-7093"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "JOSEPH",
"middle_name": "VINCENT",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-09-07",
"last_updated": "2023-09-21",
"certification_date": "2023-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WA",
"license": "DE60232759",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NE",
"license": "7685",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.