NPIMap

Organization Active NPI

Sullivan Dentistry,LLC

  • Dentist
  • Mukwonago, WI
National Provider Identifier
1780877571
Registry record updated Aug 24, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
5098-015 Issued in WI
Legal business name
SULLIVAN DENTISTRY,LLC
Practice address
920 Greenwald CT
Ste 300
Mukwonago, WI 53149-1711
Phone
(262) 642-2296
NPI assigned
Aug 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. John S Sullivan, DDS
Title
Owner
Phone
(262) 642-2296

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 5098-015 WI Primary

Addresses

Primary practice location

920 Greenwald CT
Ste 300
Mukwonago, WI 53149-1711

Mailing address

N9225 S Shore Dr
East Troy, WI 53120-2178
Phone (262) 642-2296

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1187913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187913600000",
    "number": "1780877571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N9225 S SHORE DR",
            "city": "EAST TROY",
            "state": "WI",
            "postal_code": "531202178",
            "telephone_number": "262-642-2296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 GREENWALD CT",
            "address_2": "STE 300",
            "city": "MUKWONAGO",
            "state": "WI",
            "postal_code": "531491711",
            "telephone_number": "262-642-2296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SULLIVAN DENTISTRY,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-24",
        "last_updated": "2007-08-24",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-642-2296",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "WI",
            "license": "5098-015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mukwonago, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.