John Michael Sullivan, D.M.D, M.S.

Primary specialty

DentistTaxonomy code 122300000X

License

DN18659 Issued in FL

Practice address

9770 Old Baymeadows Rd Ste 113
Jacksonville, FL 32256-7986

Phone

(904) 636-8999

Fax

(904) 998-7804

NPI assigned

Jul 14, 2009

Sex

Male

Sole proprietor

Yes

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

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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

{
    "created_epoch": "1247529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355788800000",
    "number": "1679703425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9770 OLD BAYMEADOWS RD STE 113",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322567986",
            "telephone_number": "904-636-8999",
            "fax_number": "904-998-7804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9770 OLD BAYMEADOWS RD STE 113",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322567986",
            "telephone_number": "904-636-8999",
            "fax_number": "904-998-7804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "JOHN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.M.D, M.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-07-14",
        "last_updated": "2012-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN18659",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deyja Sullivan
• Gloria Cherish Hope Sullivan, CRNA
• Helen Sullivan, LDO
• Jacqueline Sullivan, BCBA
• John F. Sullivan, D.O.
• John P Sullivan, MD
• Kara Sullivan, DPT
• Kimberly Sullivan, LMT
• Luz Yorlady Sullivan, MD
• Matthew Sullivan, PA

• Dentist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.