Active NPI
Brian Lawrence Sullivan Jr., DMD
- Dentist
- Derry, NH
National Provider Identifier
1740859966
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 04654
- Practice address
- 55 E Broadway Unit 1
Derry, NH 03038-2401 - Phone
- (603) 548-3865
- NPI assigned
- Jun 22, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 04654 | NH | Primary |
Addresses
Primary practice location
55 E Broadway Unit 1
Derry, NH 03038-2401
Mailing address
373 Haverhill Rd
Chester, NH 03036-4209
Phone (603) 548-3865
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 |
|---|---|---|---|
| 04654 | NH | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1624320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624320000000",
"number": "1740859966",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "373 HAVERHILL RD",
"city": "CHESTER",
"state": "NH",
"postal_code": "030364209",
"telephone_number": "603-548-3865"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 E BROADWAY UNIT 1",
"city": "DERRY",
"state": "NH",
"postal_code": "030382401",
"telephone_number": "603-548-3865"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "BRIAN",
"middle_name": "LAWRENCE",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-06-22",
"last_updated": "2021-06-22",
"certification_date": "2021-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NH",
"license": "04654",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Derry, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.