Stacy Lynn Sullivan, DDS, MS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

2901021156 Issued in MI

Practice address

36600 Heritage Dr
Richmond, MI 48062-1937

Phone

(586) 727-5500

NPI assigned

Oct 31, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Stacy Lynn Baker Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1351641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412812800000",
    "number": "1598019325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 OAK AVE",
            "address_2": "UNIT 303",
            "city": "BIRMINGHAM",
            "state": "MI",
            "postal_code": "480091389",
            "telephone_number": "734-945-7435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36600 HERITAGE DR",
            "city": "RICHMOND",
            "state": "MI",
            "postal_code": "480621937",
            "telephone_number": "586-727-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "STACY",
        "middle_name": "LYNN",
        "credential": "DDS, MS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-31",
        "last_updated": "2014-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MI",
            "license": "2901021156",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IL",
            "license": "319.018288",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACY",
            "last_name": "BAKER",
            "middle_name": "LYNN",
            "credential": "DDS, MS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Abby Elaine Stewart
• Tammy Michelle Stinson
• Cynthia Lee Stovall, COTA
• Theresa Dilaura Strongarone
• Katherine Sturtevant, LPC
• Seth Swanson
• Monica Szczerbinski
• Susan M Tazzi
• Patricia Tennyson
• John Raymond Tihansky

• Pediatric Dentistry in Richmond, MI
• Providers in Richmond, MI by specialty
• Pediatric Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2014; 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.