Trinity River Dental Professional Corporation

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

54500 Issued in CA

Legal business name

TRINITY RIVER DENTAL PROFESSIONAL CORPORATION

Doing business as

Northern California Dental Sleep Therapy Center

Practice address

1619 N Waterfront Pkwy
Wichita, KS 67206-6602

Phone

(916) 517-9905

NPI assigned

Aug 23, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Preddis Leroy Sullivan, DDSNPI 1477616662

Title

President

Phone

(916) 517-9905

Specialties & licenses 1

Addresses

Other names 1

• Northern California Dental Sleep Therapy Center Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Preddis Leroy Sullivan, DDS

  • General Practice Dentistry
  • Wichita, KS
  • NPI 1477616662
  NPD Authorized official

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

{
    "created_epoch": "1282521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665014400000",
    "number": "1326354754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3620 N CREST CT",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672261019",
            "telephone_number": "916-517-9905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1619 N WATERFRONT PKWY",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672066602",
            "telephone_number": "916-517-9905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRINITY RIVER DENTAL PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-23",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "PREDDIS",
        "authorized_official_middle_name": "LEROY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "916-517-9905",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "54500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northern California Dental Sleep Therapy Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Trina Health-Witchita N.W., LLC (Trina Health of Wichita)
• Trinh John
• Trinity Chiropractic Inc.
• Trinity Hospice of Kansas
• Trinity Medical, LLC
• Susan June Young Tripodi, APRN
• Triumph Ministries
• Stacy Trollinger, LPC
• Janna S Trombold, MD
• Ashley Ann Trood

• General Practice Dentistry in Wichita, KS
• Providers in Wichita, KS by specialty
• General Practice Dentistry in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.