Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 16545 | OH |
NPI | 1033276837 |
---|---|
Provider Name | Dr. David Michael Sullivan |
First Address | Cincinnati, OH 45211-1900 |
Second Address | Cincinnati, OH 45211-1900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 08/07/2007 |