JERRY L SULLIVAN (NPI# 1093929044) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093929044 |
| Entity Type | Individual |
| Full Name | JERRY L SULLIVAN |
| Credential | DDS |
| Practice Address |
411 Grandview Ave Kingman AZ 86401-5745 |
| Practice Telephone | 9287536611 |
| Practice Fax Number | 9287531288 |
| Mailing Telephone | 9287536611 |
| Mailing Fax Number | 9287531288 |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
3296 | AZ | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457409807 | Jerry Sullivan | Nurse Practitioner | 120 Market Street, Woodland, MS 39776 | 2007-01-08 |
| 1306909551 | Jerry L. Sullivan Jr. | Specialist/Technologist | 3631 S. Sixth Street, Springfield, IL 62703 | 2006-12-19 |
| 1083697742 | Jerry L Sullivan | Dentist | 1007 Reelfoot Ave, Union City, TN 38261 | 2005-11-26 |
| 1306998406 | Jerry J. Sullivan | Family Medicine | 6501 Loisdale Ct, Springfield, VA 22150-1826 | 2007-01-17 |
| 1689697641 | Jerry Warner Sullivan | Internal Medicine | 301 N Jefferson Davis Pkwy, 1st Floor, New Orleans, LA 70119-5311 | 2006-07-25 |
| 1487631594 | Jerry Sullivan | Physical Therapist | 1975 Lin Lor Ln, Elgin, IL 60123-4902 | 2005-12-29 |
| 1629062724 | Jerry Sullivan | Physician Assistant | 2225 Us Highway 41 N, Tifton, GA 31794-2749 | 2005-09-02 |
| Street Address |
411 GRANDVIEW AVE |
| City | KINGMAN |
| State | AZ |
| Zip Code | 86401-5745 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912010216 | Jerald D Wienke | Dentist | 411 Grandview Ave, Kingman, AZ 86401-5745 | 2006-08-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053858704 | Robert Cole | Nurse Practitioner | 3545 Cheyenne Ave, King,an, AZ 86401 | 2017-01-19 |
| 1710420286 | Acadia Healthcare Inc | Nurse Practitioner | 2699 E Andy Devine, Suite B, Kingman, AZ 86401 | 2016-11-30 |
| 1174079800 | Kenneth Mcadow | Physical Therapist | 2404 Stockton Hill Road, Suite K, Kingman, AZ 86401 | 2016-09-01 |
| 1649659483 | Tracie Hirz | Case Manager/Care Coordinator | 3656 Packsaddle Road, Kingman, AZ 86401 | 2015-05-27 |
| 1548657695 | Chelsea Presbrey | Family Medicine | 2202 N Stockton Hill Rd Ste 100, Kingman, AZ 86401 | 2015-04-15 |
| 1649617226 | Abubakr Abdelmunim Tagelsir Abdelaziz | Internal Medicine | 2501 N Stockton Hill Rd Ste 102, Kingman, AZ 86401 | 2013-05-23 |
| 1205173325 | Patricia Jean Marko | Social Worker | 2002 Stockton Hill Road, Mohave Mental Health Clinic, Inc., Kingman, AZ 86401 | 2013-01-09 |
| 1770835316 | Hae Young Lee | Dentist | 2058 Maya Dr., Kingman, AZ 86401 | 2012-10-05 |
| 1255681623 | Hilary Radler | Specialist/Technologist | 3033 Macdonald, Kingman, AZ 86401 | 2012-09-13 |
| 1477836880 | Goodwill of Northern Arizona | Exclusive Provider Organization | 2369 Airway Avenue, Kingman, AZ 86401 | 2011-09-21 |
| Find all providers in zip 86401 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184282253 | Hongha Nguyen | Dentist | 1848 Hope Ave Ste 2, Kingman, AZ 86401-4190 | 2019-06-03 |
| 1669949582 | Riata Valley Dental Group | Dentist | 1111 Riata Valley Rd Ste 350, Kingman, AZ 86409-3719 | 2018-10-29 |
| 1740649342 | Terry W Greenstein Dds LLC | Dentist | 126 W B Ave, Kingman, KS 67068-1309 | 2016-02-11 |
| 1770835316 | Hae Young Lee | Dentist | 2058 Maya Dr., Kingman, AZ 86401 | 2012-10-05 |
| 1225274087 | Kids Little Smiles Dentistry | Dentist | 2202 Hualapai Mountain Rd Ste 201, Kingman, AZ 86401-8337 | 2008-12-29 |
| 1013118306 | Conchita O Mercado | Dentist | 1101 Riata Valley Rd, Kingman, AZ 86409 | 2007-05-31 |
| 1821166760 | Barry J Uldrikson | Dentist | 1101 Riata Valley Rd., Kingman, AZ 86409 | 2006-11-30 |
| 1750469441 | Keith Wayne Hodgkin | Dentist | 5218 Stockton Hill Rd, Kingman, AZ 86409-1042 | 2006-11-01 |
| 1912010216 | Jerald D Wienke | Dentist | 411 Grandview Ave, Kingman, AZ 86401-5745 | 2006-08-17 |
| 1124034251 | Robert Anderson | Dentist | 3775 Stockton Hill Rd Ste C, Kingman, AZ 86409 | 2006-07-31 |
| Find all providers in KINGMAN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.