Jennifer Chang Sullivan, D.D.S., MSD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

1859858 Issued in MA

Practice address

35 Bedford St Ste 20
Lexington, MA 02420-4440

Phone

(617) 468-8696

NPI assigned

Feb 22, 2013

Last updated

Oct 1, 2023By 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 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Aug 17, 2021 through Aug 17, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Wang Periodontics PLLC

  dba Maple Grove Periodontics and Implant Dentistry

  • Periodontics
  • Maple Grove, MN
  • NPI 1093442048
  NPD

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

{
    "created_epoch": "1361491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696118400000",
    "number": "1356681654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 BEDFORD ST STE 20",
            "city": "LEXINGTON",
            "state": "MA",
            "postal_code": "024204440",
            "telephone_number": "617-468-8696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 BEDFORD ST STE 20",
            "city": "LEXINGTON",
            "state": "MA",
            "postal_code": "024204440",
            "telephone_number": "617-468-8696"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "290 Baker Ave Ste 103",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "MA",
            "postal_code": "017422189",
            "country_code": "US",
            "telephone_number": "617-468-8696",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "JENNIFER",
        "middle_name": "CHANG",
        "name_prefix": "Dr.",
        "credential": "D.D.S., MSD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-02-22",
        "last_updated": "2023-10-01",
        "certification_date": "2023-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MN",
            "license": "S125",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "TX",
            "license": "26373",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MA",
            "license": "1859858",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peri Strongwater, MT-BC
• Ronalyn Stuart
• Balachundhar Subramaniam, M.B.B.S, M.D.
• Aidan James Sullivan
• Carol Elizabeth Sullivan, MS, RD, CSO, LDN
• Paul Joseph Sullivan, PHD
• Claire Coassin Sumner, BCBA
• Arthur F. Sun, D.M.D.
• Justin Sunly
• Kelly Ann Sutton

• Periodontics in Lexington, MA
• Providers in Lexington, MA by specialty
• Periodontics in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.