Provider Demographics
NPI:1043552664
Name:SULLIVAN, LAWRENCE P (DDS)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:P
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 1:11 SPARTA AVE
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1801
Mailing Address - Country:US
Mailing Address - Phone:973-729-3785
Mailing Address - Fax:973-729-4813
Practice Address - Street 1:11 SPARTA AVE
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1801
Practice Address - Country:US
Practice Address - Phone:973-729-3785
Practice Address - Fax:973-729-4813
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01212400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist