GRACIELA K SULLIVAN DDS INC (NPI# 1316239619) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316239619 |
| Entity Type | Organization |
| Organization Name | GRACIELA K SULLIVAN DDS INC |
| Other Organization Name | GRACIELA SULLIVAN DDS. MS. PEDIATRIC DENTIST |
| Practice Address |
5112 Warner Ave Ste 104 Huntington Beach CA 92649-6036 |
| Practice Telephone | 7143772628 |
| Practice Fax Number | 7143770090 |
| Mailing Telephone | 7143772628 |
| Enumeration Date | 2011-05-05 |
| Last Update Date | 2011-05-05 |
| Authorized Official Name | MRS. GRACIELA K SULLIVAN (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 7143772628 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities | ||
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
Dental Providers |
| Other Name | Type Code |
|---|---|
| Graciela Sullivan DDS. MS. Pediatric Dentist | Doing Business As Name - Organization |
| Street Address |
5112 WARNER AVE STE 104 |
| City | HUNTINGTON BEACH |
| State | CA |
| Zip Code | 92649-6036 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225639305 | Tanisha Grant | Behavioral Analyst | 4592 Warner Ave, Huntington Beach, CA 92649 | 2020-11-04 |
| 1023582772 | Stanley Wayne Combs | Emergency Medicine | 16761 Edgewater Lane, Huntington Beach, CA 92649 | 2019-01-16 |
| 1609382084 | Loc Do | Pharmacist | 16922 Bolsa Chica, Huntington Beach, CA 92649 | 2017-12-20 |
| 1487166765 | Holly Forman | Marriage & Family Therapist | 17121 Tiffany Circle, Huntington Beach, CA 92649 | 2017-10-26 |
| 1205362522 | Pmh Laboratory Inc | Clinical Medical Laboratory | 5862 Edinger Ave, Huntington Beach, CA 92649 | 2017-05-05 |
| 1972050086 | Clear Reflections Psychol Assocs | Social Worker | 16897 Algonquin St., Ste L, Huntington Beach, CA 92649 | 2016-09-07 |
| 1588011274 | Wisdom Foods Inc | Dietitian, Registered | 16987 Algonquin Street Suite L, Huntington Beach, CA 92649 | 2016-05-23 |
| 1801253398 | Thierry Kolpin | Psychologist | 5202 Edinger, Huntington Beach, CA 92649 | 2016-01-28 |
| 1811374242 | Margarita Bernardo Velarde | Pediatrics | 17392 Wildrose Lane, Huntington Beach, CA 92649 | 2015-05-06 |
| 1023439809 | Orange County Labs Inc. | Clinical Medical Laboratory | 15165 Triton Ln, Huntington Beach, CA 92649 | 2013-12-23 |
| Find all providers in zip 92649 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518354653 | Van-khoa Quan | Dentist | 9842 Adams Ave Ste 101, Huntington Beach, CA 92646-4827 | 2015-04-15 |
| 1699905430 | Amit Shah | Dentist | 18377 Beach Blvd Ste 216, Huntington Beach, CA 92648-1349 | 2009-07-14 |
| 1215955299 | Richard Paul Mungo | Dentist | 7891 Talbert Ave Ste 103, Huntington Beach, CA 92648-1319 | 2006-07-17 |
| 1497758304 | John Andrew Guijon | Dentist | 18700 Main St, Ste 210, Huntington Beach, CA 92648-1714 | 2005-05-24 |
| 1326513771 | Amit A Shah Dds Inc | Dentist | 18377 Beach Blvd Ste 216, Huntington Beach, CA 92648-1349 | 2018-10-11 |
| 1154745842 | Paul Alan Reggiardo | Dentist | 17742 Beach Blvd, Suite 320, Huntington Beach, CA 92647-6818 | 2014-02-14 |
| 1902145246 | Richard P. Mungo D.d.s., M.s.d., M.ed. | Dentist | 7891 Talbert Ave, Suite 103, Huntington Beach, CA 92648-8612 | 2013-02-06 |
| 1831378215 | Suelene Y. Chen, D.d.s. Inc. | Dentist | 17692 Beach Blvd, Suite 303, Huntington Beach, CA 92647-6837 | 2007-11-01 |
| 1124148093 | Beanca Chu, Dds, A Professional Corporation | Dentist | 20932 Brookhurst St, Suite #102, Huntington Beach, CA 92646-6638 | 2007-04-02 |
| 1588716633 | Suelene Yeong Yu Chen | Dentist | 16900 Goldenwest St, Suite A, Huntington Beach, CA 92647-8405 | 2007-01-17 |
| Find all providers in HUNTINGTON BEACH | ||||
| City | HUNTINGTON BEACH |
| Zip Code | 92649 |
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| 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.