Active NPI
Coleen Sullivan, DDS
- General Practice Dentistry
- Hilo, HI
National Provider Identifier
1669466280
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DT-2596
- Practice address
- 400 Hualani St
BLDG 9 Suite 192
Hilo, HI 96720-4378 - Phone
- (808) 935-6620
- Fax
- (808) 935-6781
- NPI assigned
- Sep 9, 2005
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4503 | AZ | |
| General Practice Dentistry | 1223G0001X | DT-2596 | HI | Primary |
Addresses
Primary practice location
400 Hualani St
BLDG 9 Suite 192
Hilo, HI 96720-4378
Mailing address
400 Hualani St
BLDG 9 Suite 192
Hilo, HI 96720-4378
Phone (808) 935-6620
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 191958 | Medicaid | AZ |
Other names 1
- Coleen Barry
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 |
|---|---|---|---|
| DT-2596 | HI | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hawaii Dental Group, Inc. | General Practice | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126224000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1482105600000",
"number": "1669466280",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 HUALANI ST",
"address_2": "BLDG 9 SUITE 192",
"city": "HILO",
"state": "HI",
"postal_code": "967204378",
"telephone_number": "808-935-6620",
"fax_number": "808-523-3121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 HUALANI ST",
"address_2": "BLDG 9 SUITE 192",
"city": "HILO",
"state": "HI",
"postal_code": "967204378",
"telephone_number": "808-935-6620",
"fax_number": "808-935-6781"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "COLEEN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-09-09",
"last_updated": "2016-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AZ",
"license": "4503",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "HI",
"license": "DT-2596",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "191958",
"state": "AZ"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "COLEEN",
"last_name": "BARRY",
"credential": "DDS",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Hilo, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.