NPIMap

Organization Active NPI

John M. Sullivan DDS, PLLC

  • Dentist
  • Burton, MI
National Provider Identifier
1790158905
Registry record updated Nov 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2901012666 Issued in MI
Legal business name
JOHN M. SULLIVAN DDS, PLLC
Practice address
5136 Davison Rd
Burton, MI 48509-1569
Phone
(810) 742-6060
Fax
(810) 742-3022
NPI assigned
Nov 10, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2015

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

Authorized official

Name
Dr. John M. Sullivan, DDS
Title
Owner
Phone
(810) 742-6060

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 2901012666 MI Primary

Addresses

Primary practice location

5136 Davison Rd
Burton, MI 48509-1569

Mailing address

5136 Davison Rd
Burton, MI 48509-1569
Phone (810) 742-6060

National Provider Directory

National Provider Directory

Locations

5136 Davison Rd
Burton, MI 48509
Phone (810) 742-6060

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1447113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447113600000",
    "number": "1790158905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5136 DAVISON RD",
            "city": "BURTON",
            "state": "MI",
            "postal_code": "485091569",
            "telephone_number": "810-742-6060",
            "fax_number": "810-742-3022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5136 DAVISON RD",
            "city": "BURTON",
            "state": "MI",
            "postal_code": "485091569",
            "telephone_number": "810-742-6060",
            "fax_number": "810-742-3022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN M. SULLIVAN DDS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-10",
        "last_updated": "2015-11-10",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "810-742-6060",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901012666",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burton, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2015; 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.