Marilee J Sullivan, RDH/EPDH
Individual provider Active NPI Dental Hygienist · Aurora, OR
NPI 1295002129 · NPPES record last updated Nov 21, 2011
Key facts
- NPI
- 1295002129
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dental Hygienist 124Q00000X
- License
- H0550 (OR)
- Practice address
- 21186 Sayre Drive
Aurora, OR 97002 - Phone
- (503) 984-2860
- NPI assigned
- Nov 21, 2011
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| H0550 | OR | MD | Dental Hygienist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | H0550 | OR | Yes |
Addresses
Primary practice location
21186 Sayre Drive
Aurora, OR 97002
Mailing address
PO Box 34
Aurora, OR 97002-0034
Phone (503) 678-2860
Other providers in Aurora, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 21, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.