Active NPI
Samuel Clifton Sullivan, DMD
- Dentist
- Batesville, MS
National Provider Identifier
1487586491
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 112661
- Practice address
- 160 Cracker Barrell Dr
Batesville, MS 38606-3031 - Phone
- (662) 563-7821
- NPI assigned
- Jun 2, 2026
- Sex
- Male
- 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 | 112661 | MS | Primary |
Addresses
Primary practice location
160 Cracker Barrell Dr
Batesville, MS 38606-3031
Mailing address
160 Cracker Barrell Dr
Batesville, MS 38606-3031
Phone (662) 563-7821
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 |
|---|---|---|---|
| 112661 | MS | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Batesville Premier Dental PLLC | 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 and National Provider Directory roles.
-
- Dental Clinic/Center
- Batesville, MS
- NPI 1033095054
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1780358400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1780358400000",
"number": "1487586491",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "160 CRACKER BARRELL DR",
"city": "BATESVILLE",
"state": "MS",
"postal_code": "386063031",
"telephone_number": "662-563-7821"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "160 CRACKER BARRELL DR",
"city": "BATESVILLE",
"state": "MS",
"postal_code": "386063031",
"telephone_number": "662-563-7821"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "SAMUEL",
"middle_name": "CLIFTON",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-06-02",
"last_updated": "2026-06-02",
"certification_date": "2026-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MS",
"license": "112661",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Batesville, MS
- Strategic Anesthesia Partners LLC
- Strategic Solutions-Panola Medical Center LLC
- Strategic Solutions-Panola Medical Center LLC
- Strategic Solutions-Panola Medical Center LLC
- Shaniqua Strong, RN
- Stephen E. Sullivan III, D.D.S
- Sullivan'S Drug Store,Inc
- Jennifer J Sullivant, R.PH.
- Sunrise Medical Group PLLC
- Superior MRI Services, Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.