Daniel T Sullivan, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

39928 Issued in CA

Practice address

4655 Hoen Ave
Suite #6
Santa Rosa, CA 95405-7830

Phone

(707) 545-5260

Fax

(707) 545-5077

NPI assigned

Feb 5, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1588703631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4655 HOEN AVE",
            "address_2": "SUITE #6",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954057830",
            "telephone_number": "707-545-5260",
            "fax_number": "707-545-5077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4655 HOEN AVE",
            "address_2": "SUITE #6",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954057830",
            "telephone_number": "707-545-5260",
            "fax_number": "707-545-5077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "DANIEL",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "39928",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Austin Sue, M.D.
• Jeffrey Louis Sugarman, M.D., PH.D.
• Leslie Michelle Sugiyama, PHARMD, RPH
• Fathima Keshia Suhail, MD
• Andrea Sullivan
• Ellen Marie Sullivan
• Gene Sullivan, ND
• Jenny Marie N Sullivan, M.D.
• Mary Ellen Sullivan
• Scott Louis Sullivan, DDS

• Dentist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.