Active NPI
Cody Lee Sullivan, DDS
- Dentist
- Camp Pendleton, CA
National Provider Identifier
1942795877
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2018021980
- Practice address
- 200 Mercy Circle
Camp Pendleton, CA 92055-5191 - Phone
- (760) 725-3417
- NPI assigned
- Jun 23, 2018
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 0401418537 | VA | |
| Dentist | 122300000X | 2018021980 | MO | Primary |
Addresses
Primary practice location
200 Mercy Circle
Camp Pendleton, CA 92055-5191
Mailing address
200 Mercy Circle
Camp Pendleton, CA 92005
Phone (760) 725-3879
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 |
|---|---|---|---|
| 2018021980 | MO | MD | Dentist |
| 0401418537 | VA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1529712000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738540800000",
"number": "1942795877",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 MERCY CIRCLE",
"city": "CAMP PENDLETON",
"state": "CA",
"postal_code": "92005",
"telephone_number": "760-725-3879"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 MERCY CIRCLE",
"city": "CAMP PENDLETON",
"state": "CA",
"postal_code": "920555191",
"telephone_number": "760-725-3417"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "CODY",
"middle_name": "LEE",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-06-23",
"last_updated": "2025-02-03",
"certification_date": "2025-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VA",
"license": "0401418537",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MO",
"license": "2018021980",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Camp Pendleton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.