Provider Demographics
NPI:1679522130
Name:SULLIVAN, ASHLEY H (DDS)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:H
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5316 SUNSET RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37914-4304
Mailing Address - Country:US
Mailing Address - Phone:865-525-6995
Mailing Address - Fax:865-525-5085
Practice Address - Street 1:4820 ASHEVILLE HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37914-4252
Practice Address - Country:US
Practice Address - Phone:865-525-6995
Practice Address - Fax:865-525-5085
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0000004035122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist