Kyle Sullivan, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5366921-9922 Issued in UT

Practice address

121 W Poplar St
Ste a
Walla Walla, WA 99362-2871

Phone

(509) 525-3522

NPI assigned

Jan 27, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kyle D Sullivan, DMD, PLLC

  dba Sullivan Family Dental

  • Dental Clinic/Center
  • Walla Walla, WA
  • NPI 1346718244
  NPD (past) Authorized official
• A S Pearson Jr DDS PS

  • Dentist
  • Walla Walla, WA
  • NPI 1801900840
  NPD (past)

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

{
    "created_epoch": "1169856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1302048000000",
    "number": "1962558106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 W POPLAR ST",
            "address_2": "STE A",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993622871",
            "telephone_number": "509-525-3522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 W POPLAR ST",
            "address_2": "STE A",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993622871",
            "telephone_number": "509-525-3522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KYLE",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-27",
        "last_updated": "2011-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "5366921-9922",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60083262",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Geoff Stuart, DDS
• Student Health Options (The Health Center)
• Jesse Styner
• Suasor Mentis, PLLC
• Derek E Sucharda, PAC
• Haley Elizabeth Sumner
• Andi Lee Sundberg
• Richard Jon Sundberg, D.D.S.
• Sunrise Family Counseling, LLC (Scherry Levy DBA Sunrise Family Counseling, LLC)
• Surgical Specialists Field & Newbold PLLC (Surgical Specialists of Walla Walla)

• General Practice Dentistry in Walla Walla, WA
• Providers in Walla Walla, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2011; 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.