Provider Demographics
NPI:1861546517
Name:SULLIVAN, ANDREW JOSEPH JR (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JOSEPH
Last Name:SULLIVAN
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:25 MONTVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-2034
Mailing Address - Country:US
Mailing Address - Phone:973-376-7618
Mailing Address - Fax:973-376-0073
Practice Address - Street 1:19 W 33RD ST
Practice Address - Street 2:A
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3916
Practice Address - Country:US
Practice Address - Phone:201-437-9098
Practice Address - Fax:201-436-1595
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ93141223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics