Provider Demographics
NPI:1063439636
Name:SULLIVAN, JOSEPH E (DMD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:E
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 S CHURCH ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-2773
Mailing Address - Country:US
Mailing Address - Phone:856-235-0449
Mailing Address - Fax:856-235-6988
Practice Address - Street 1:285 S CHURCH ST
Practice Address - Street 2:SUITE 8
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-2773
Practice Address - Country:US
Practice Address - Phone:856-235-0449
Practice Address - Fax:856-235-6988
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI015377-011223G0001X
NJ22DI01537702122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice