NPIMap

Organization Active NPI

Sullivan Dental Center

  • Pediatric Dentistry
  • Saint Francisville, LA
National Provider Identifier
1598873580
Registry record updated Aug 22, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
4988 Issued in LA
Legal business name
SULLIVAN DENTAL CENTER
Practice address
5436 Commerce St
St Francisville, LA 70775
Phone
(225) 635-4422
Fax
(225) 241-7155
NPI assigned
Aug 29, 2006
Last updated
Aug 22, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2007

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

Authorized official

Name
Lillian Reynolds
Title
Director
Phone
(225) 635-4422

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 5062 LA
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 5558 LA
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X 4988 LA Primary

Addresses

Primary practice location

5436 Commerce St
St Francisville, LA 70775

Mailing address

PO Box 2880
St Francisville, LA 70775
Phone (225) 635-4422

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187740800000",
    "number": "1598873580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2880",
            "city": "ST FRANCISVILLE",
            "state": "LA",
            "postal_code": "70775",
            "telephone_number": "225-635-4422",
            "fax_number": "225-635-2171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5436 COMMERCE ST",
            "city": "ST FRANCISVILLE",
            "state": "LA",
            "postal_code": "70775",
            "telephone_number": "225-635-4422",
            "fax_number": "225-241-7155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SULLIVAN DENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-29",
        "last_updated": "2007-08-22",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "LILLIAN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "225-635-4422"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "LA",
            "license": "5062",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "LA",
            "license": "5558",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "LA",
            "license": "4988",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Francisville, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.