Mark Robert Sullivan, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12343 Issued in MI

Practice address

54951 Mound Rd
Shelby Township, MI 48316-6028

Phone

(586) 797-9118

Fax

(586) 797-9085

NPI assigned

Jul 20, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Mark R Sullivan DDS

  • General Practice Dentistry
  • Shelby TWP, MI
  • NPI 1851461347
  NPD (past) Authorized official

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

{
    "created_epoch": "1184889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464134400000",
    "number": "1407056112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55191 SHELBY RD",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483161150",
            "telephone_number": "586-797-9118",
            "fax_number": "586-797-9085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54951 MOUND RD",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483166028",
            "telephone_number": "586-797-9118",
            "fax_number": "586-797-9085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MARK",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-20",
        "last_updated": "2016-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "12343",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4062594",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katlynn Frances Strnad
• Pamela Gail Strong
• Michael S Su, DDS
• Kaus Sulaka
• Marissa Anne Sulich, DDS
• Rachel Sullivan, LPC
• Summit Sleep Center, PLLC
• Supplemental Nursing Services Inc
• Maureen Nicole Sutter, R.D.H
• SVS Vision Inc

• General Practice Dentistry in Shelby Township, MI
• Providers in Shelby Township, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2016; 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.