Active NPI
Michael F Sullivan, DMD
- Periodontics
- Cherry Hill, NJ
National Provider Identifier
1215174677
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 11133
- Practice address
- 1416 Brace Rd.
Only 1 Office
Cherry Hill, NJ 08034 - Phone
- (856) 795-8020
- Fax
- (856) 795-9785
- NPI assigned
- Jan 7, 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 11133 | NJ | Primary |
Addresses
Primary practice location
1416 Brace Rd.
Only 1 Office
Cherry Hill, NJ 08034
Mailing address
1416 Brace Rd.
Cherry Hill, NJ 08034
Phone (856) 795-8020
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11133 | Other | DELTA |
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 |
|---|---|---|---|
| 11133 | NJ | MD | Periodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Professional Anesthesia Consultants, PC | Past | Accepting new patients | |
| Dr Sullivan Dr Yasner Dr Kazemi LLC | Periodontics | 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.
-
- Periodontics
- Cherry Hill, NJ
- NPI 1700941028
-
- Anesthesiology Physician
- Bethesda, MD
- NPI 1841273869
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1231286400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788652800000",
"number": "1215174677",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1416 BRACE RD.",
"city": "CHERRY HILL",
"state": "NJ",
"postal_code": "08034",
"telephone_number": "856-795-8020",
"fax_number": "856-795-9785"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1416 BRACE RD.",
"address_2": "ONLY 1 OFFICE",
"city": "CHERRY HILL",
"state": "NJ",
"postal_code": "08034",
"telephone_number": "856-795-8020",
"fax_number": "856-795-9785"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "MICHAEL",
"middle_name": "F",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-01-07",
"last_updated": "2026-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "NJ",
"license": "11133",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DELTA",
"identifier": "11133",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Cherry Hill, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.