Randy Lee Sullivan DMD

NPI 1003098609 - Dentist - 122300000X

NPI Details
NPI 1003098609
Gender Male
Enumeration Date 12/05/2007
Last Updated 12/05/2007
Entity Type Individual
Active Over 9 years ago
Practice Location
7080 GREENBRIAR DR
RANDY L SULLIVAN DMD
SOUTHAVEN MS, 38671, US
Phone (662) 393-7970
Fax (662) 393-8271
Business Location
PO BOX 350
SOUTHAVEN MS, 38671, US
Phone (662) 393-7970
Fax (662) 393-8271
Toxanomy
Taxonomy Code 122300000X
License State Mississippi
License Number 220385
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According to our database, Dr. Randy Lee Sullivan DMD NPI is 1003098609, taxonomy code is 122300000X and license number is 220385, license state is located at Mississippi. Randy Lee Sullivan DMD physically located at 7080 Greenbriar Dr, Southaven MS, 38671. NPI Number Randy Lee Sullivan DMD has the Individual type.

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1003098609 NPI number is provided on an as is basis without warranty of any kind. 1003098609 is maintained by the National Plan & Provider Enumeration System. The contents of Randy Lee Sullivan DMD are for informational purposes only.