DR. JACKSON LEE SULLIVAN (NPI# 1194733725) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194733725 |
| Entity Type | Individual |
| Full Name | DR. JACKSON LEE SULLIVAN |
| Credential | D.D.S., PC |
| Practice Address |
609 S Kelly Ave E-1 Edmond OK 73003-5659 |
| Practice Telephone | 4058448444 |
| Practice Fax Number | 4058448440 |
| Mailing Telephone | 4058448444 |
| Mailing Fax Number | 4058448440 |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223E0200X |
Dentist Specialization: Endodontics |
5244 | OK | Dental Providers |
| Street Address |
609 S KELLY AVE E-1 |
| City | EDMOND |
| State | OK |
| Zip Code | 73003-5659 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366465114 | Karen Gallagher Reed | Dentist | 609 S Kelly Ave, Suite A1, Edmond, OK 73003 | 2006-07-25 |
| 1285974220 | Quality Sleep Specialists, LLC | Clinic/Center | 609 S Kelly Ave, Ste B-1, Edmond, OK 73003-5659 | 2013-02-28 |
| 1811237852 | Quality Sleep Specialists, LLC | Clinic/Center | 609 S Kelly Ave, B-1, Edmond, OK 73003-5659 | 2013-02-28 |
| 1326295338 | Tiffany Nicole Bankston | Physician Assistant | 609 S Kelly Ave, Suite J1, Edmond, OK 73003-5659 | 2008-08-20 |
| 1215194162 | Michael F. Alspaugh | Dentist | 609 S Kelly Ave, Suite A1, Edmond, OK 73003-5659 | 2008-05-19 |
| 1063567022 | Michael F Alspaugh | Dentist | 609 S Kelly Ave, Suite A1, Edmond, OK 73003-5659 | 2007-01-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154945202 | Korbin Hally | Dentist | 2600 Tayler Street, Edmond, OK 73003 | 2020-06-04 |
| 1003448325 | Diagnostic Resources, LLC | Physical Medicine & Rehabilitation | 1641 Saratoga Way, Edmond, OK 73003 | 2020-02-05 |
| 1861904021 | Rhonda Diane Pennington | Occupational Therapist | 515 S Santa Fe Ave Ste 103, Edmond, OK 73003 | 2017-10-27 |
| 1588173744 | Hpc Holdings LLC | Clinic/Center | 813 W Covell Rd, Edmond, OK 73003 | 2017-09-20 |
| 1194243568 | Nightengale Chiropractic, LLC | Chiropractor | 2616 Covell Village Dr Ste. 120, Edmond, OK 73003 | 2017-09-06 |
| 1104274927 | Bonsu Osei Asibey | Case Manager/Care Coordinator | 1301 Craig Blvd, Edmond, OK 73003 | 2016-06-02 |
| 1215390810 | Prince Yebo | Case Manager/Care Coordinator | 1817 Redland Dr, Edmond, OK 73003 | 2016-03-31 |
| 1548621691 | Charles Loftis | Physical Therapist | 1321 Fretz Drive, 100, Edmond, OK 73003 | 2016-03-17 |
| 1487013801 | Courage Counseling Center | Community/Behavioral Health | 1400 S. Fretz Ave, Suite 1400, Edmond, OK 73003 | 2016-02-12 |
| 1669889887 | Shannon Gogel | Occupational Therapy Assistant | 1309 Val Genes Rd, Edmond, OK 73003 | 2014-07-21 |
| Find all providers in zip 73003 | ||||
| Taxonomy Code | 1223E0200X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Endodontics |
| The branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336366244 | Jackson L. Sullivan D.d.s., P.C. | Dentist | 609 S Kelly Ave Ste E1, Edmond, OK 73003-7501 | 2007-04-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891008272 | Reham El-hennawey | Dentist | 400 Riverwalk Ter, Ste 200, Jenks, OK 74037-5606 | 2010-07-14 |
| 1770713729 | Eugenia Johnson | Dentist | 4416 W Houston St, Broken Arrow, OK 74012-4645 | 2009-07-23 |
| 1013187186 | Denny W Southard | Dentist | 6565 S Yale Ave Ste 712, Tulsa, OK 74136-8308 | 2008-03-05 |
| 1972703734 | J. Mike Strand | Dentist | 4420 W Houston St, Broken Arrow, OK 74012-4645 | 2007-07-20 |
| 1629290242 | Kim Loren Wilkinson | Dentist | 13851 Quail Pointe Dr, Oklahoma City, OK 73134-1021 | 2007-05-03 |
| 1861532616 | Steven Eugene Powell | Dentist | 410 24th Ave Sw, Norman, OK 73069-5110 | 2007-02-08 |
| 1992843965 | Jay Scott Sullins | Dentist | 8504 Nw Cache Rd, Lawton, OK 73505-9604 | 2007-02-02 |
| 1760536866 | David W Pedicord | Dentist | 4606 E 67th Street, Suite 208, Tulsa, OK 74136 | 2007-01-23 |
| 1437207560 | David J Clement | Dentist | 1201 N Stonewall Ave., Ouhsc College of Dentistry, Oklahoma City, OK 73117 | 2007-01-08 |
| 1982616256 | William Lee Beasley I | Dentist | 4500 Memorial Cir, Oklahoma City, OK 73142-5003 | 2006-08-13 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on DR. JACKSON LEE SULLIVAN.
| 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.