Roger Barrett Sullivan Jr., DDS
Individual provider Active NPI General Practice Dentistry · Schoolcraft, MI
NPI 1669600425 · NPPES record last updated Jun 30, 2009
Key facts
- NPI
- 1669600425
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 13518 (MI)
- Practice address
- 449 N Grand St
Schoolcraft, MI 49087-9141 - Phone
- (269) 679-5285
- NPI assigned
- Jun 30, 2009
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13518 | MI | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 13518 | MI | Yes |
Addresses
Primary practice location
449 N Grand St
Schoolcraft, MI 49087-9141
Mailing address
PO Box 237
449 N. Grand St
Schoolcraft, MI 49087-0237
Phone (269) 679-5285
Other providers in Schoolcraft, MI
- Christine Annette Rosey
- Brian Randall Scott
- Tara Lee Smith
- Allyson Leigh Stein
- Allison Struber
- Emily Kay Taylor
- Vicki Thornburgh
- Paul Louis Toth
- Jamie Wolgamood
All providers in Schoolcraft, MI · General Practice Dentistry in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 30, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.