David R Sullivan, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3724 Issued in NC

Practice address

2713 Pinedale Rd
Greensboro, NC 27408-4713

Phone

(336) 288-8745

Fax

(336) 288-8747

NPI assigned

Oct 20, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

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

State licenses

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720160575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2713 PINEDALE RD",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274084713",
            "telephone_number": "336-288-8745",
            "fax_number": "336-288-8747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2713 PINEDALE RD",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274084713",
            "telephone_number": "336-288-8745",
            "fax_number": "336-288-8747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "DAVID",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "3724",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "98183",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Successful Visions LLC
• Successworks 264 LLC
• Harry Suggs Jr., LCAS
• Asmaa Suleiman
• Corinna Sullivan, M.D.
• Jakara Tanae Sullivan
• Katherine Anne Sullivan
• Laura Sullivan, LCMHCA
• Lonnie Thomas Sullivan II
• Marlie Sullivan

• General Practice Dentistry in Greensboro, NC
• Providers in Greensboro, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.