Provider Demographics
NPI:1053893024
Name:SULLIVAN FAMILY DENTISTRY, PLLC
Entity type:Organization
Organization Name:SULLIVAN FAMILY DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:HUNTER
Authorized Official - Middle Name:C
Authorized Official - Last Name:FLEENOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-298-1651
Mailing Address - Street 1:2000 RICHARD JONES RD STE 107
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2885
Mailing Address - Country:US
Mailing Address - Phone:615-298-1651
Mailing Address - Fax:615-298-1129
Practice Address - Street 1:2000 RICHARD JONES RD STE 107
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2885
Practice Address - Country:US
Practice Address - Phone:615-298-1651
Practice Address - Fax:615-298-1129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-05
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN105151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty