Mark R Sullivan DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12343 Issued in MI

Legal business name

MARK R SULLIVAN DDS

Practice address

54951 Mound Road
Shelby TWP, MI 48316-6028

Phone

(586) 797-9118

Fax

(586) 797-9085

NPI assigned

Nov 9, 2006

Last updated

Jul 17, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mark SullivanNPI 1407056112

Title

Dentist

Phone

(586) 797-9118

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mark Robert Sullivan, DDS

  • General Practice Dentistry
  • Shelby Township, MI
  • NPI 1407056112
  NPD (past) Authorized official

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184630400000",
    "number": "1851461347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54951 MOUND ROAD",
            "city": "SHELBY TWP",
            "state": "MI",
            "postal_code": "483166028",
            "telephone_number": "586-797-9118",
            "fax_number": "586-797-9085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54951 MOUND ROAD",
            "city": "SHELBY TWP",
            "state": "MI",
            "postal_code": "483166028",
            "telephone_number": "586-797-9118",
            "fax_number": "586-797-9085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK R SULLIVAN DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2007-07-17",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "586-797-9118"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "12343",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4062594",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ramy Mando, M.D.
• Adam Ryan Mandziuk, D.C.
• Mary Manni
• Rebecca A Manring, PT
• Candice Ann Mansoor, M.D.
• James Martin
• Lacey Martinez
• Tracy Marzec, PTA
• Matrix Medical PLLC
• Brittany Mattia

• General Practice Dentistry in Shelby TWP, MI
• Providers in Shelby TWP, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 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.