Sullivan, Andrea Lee

Sullivan, Andrea Lee is an individual health care provider with primary practice located at 3024 South Il-159 , Glen Carbon IL 62034. She recently has only one registered license in Dental Providers / General Practice, which is considered as her primary health care specialty. Sullivan, Andrea Lee can be contacted via phone (855) 579-2158.

Contact Information

Primary practice address
3024 South Il-159 Glen Carbon IL 62034
Phone: (855) 579-2158
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 2018003588 Missouri

Profile Details

NPI number 1871092502
LBN Legal business name Sullivan, Andrea Lee
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 8th, 2018
Last updated Mar 17th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1871092502 NPPES
Missouri Other 2018003588 MISSOURI DENTAL BOARD

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