Sullivan Family Dentistry, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

SULLIVAN FAMILY DENTISTRY, LLC

Practice address

2186 N Hospital Blvd., Suite 1
Sullivan, IN 47882-0468

Phone

(812) 268-4010

Fax

(812) 268-5607

NPI assigned

Oct 1, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Gregg W Smith, DDS

Title

Senior Partner Owner

Phone

(812) 268-4010

Specialties & licenses 2

Addresses

Locations

Practitioners 1

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

• Jessica Mae Ellsperman, DDS

  • General Practice Dentistry
  • Sullivan, IN
  • NPI 1912436635

  General Practice

  NPD (past)

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

{
    "created_epoch": "1412121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578441600000",
    "number": "1871996199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 468",
            "city": "SULLIVAN",
            "state": "IN",
            "postal_code": "478820468",
            "telephone_number": "812-268-4010",
            "fax_number": "812-268-5607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2186 N HOSPITAL BLVD., SUITE 1",
            "city": "SULLIVAN",
            "state": "IN",
            "postal_code": "478820468",
            "telephone_number": "812-268-4010",
            "fax_number": "812-268-5607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SULLIVAN FAMILY DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-01",
        "last_updated": "2020-01-08",
        "certification_date": "2020-01-08",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "GREGG",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "SENIOR PARTNER OWNER",
        "authorized_official_telephone_number": "812-268-4010",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IN",
            "license": "12007736A",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sullivan County Community Hospital
• Sullivan County Community Hospital
• Sullivan County Community Hospital
• Sullivan County Community Hospital
• Sullivan County Community Hospital
• Sullivan Family Eye Care P C
• Sullivan Family Practice, LLC
• Sullivan Health & Living Center, Inc.
• Sullivan Rehabilitation & Sports Physical Therapy, Inc.
• Sullivan Surgicenter,LLC

• All providers in Sullivan, IN
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2020; 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.