Active NPI
Christine Sullivan, DMD
- Dentist
- Glenburn, ME
National Provider Identifier
1417796335
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DEN5141
- Practice address
- 792 Stillwater Ave
Glenburn, ME 04401-3617 - Phone
- (207) 947-1166
- NPI assigned
- May 21, 2024
- Last updated
- May 21, 2024
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | DEN5141 | ME | Primary |
Addresses
Primary practice location
792 Stillwater Ave
Glenburn, ME 04401-3617
Mailing address
8 Adams Dr
Coventry, RI 02816-6213
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 |
|---|---|---|---|
| DEN5141 | ME | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Buxton Dental PC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Maine Family Dental Practice
- General Practice Dentistry
- Bangor, ME
- NPI 1619398856
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1716249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716249600000",
"number": "1417796335",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8 ADAMS DR",
"city": "COVENTRY",
"state": "RI",
"postal_code": "028166213"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "792 STILLWATER AVE",
"city": "GLENBURN",
"state": "ME",
"postal_code": "044013617",
"telephone_number": "207-947-1166"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "CHRISTINE",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-05-21",
"last_updated": "2024-05-21",
"certification_date": "2024-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "ME",
"license": "DEN5141",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glenburn, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.