BRETT MICHAEL SULLIVAN (NPI# 1629268966) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629268966 |
| Entity Type | Individual |
| Full Name | BRETT MICHAEL SULLIVAN |
| Credential | D.M.D., M.D. |
| Practice Address |
2428 Ne Wasco St Portland OR 97232 |
| Mailing Address |
2824 Ne Wasco St Portland OR 97232-1772 |
| Practice Telephone | 5413013818 |
| Mailing Telephone | 5413013818 |
| Mailing Fax Number | 5032899621 |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2014-06-20 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 122300000X | Dentist | 2007019263 | MO | Dental Providers |
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
D9737 | OR | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356385405 | Brett S Sullivan | Anesthesiology | 1000 W Moreno St, Pensacola, FL 32501-2316 | 2006-06-16 |
| Street Address |
2428 NE WASCO ST |
| City | PORTLAND |
| State | OR |
| Zip Code | 97232 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881293215 | Oregon Change Clinic | Clinic/Center | 650 Ne Holladay Street, Suite 1600, Portland, OR 97232 | 2020-10-17 |
| 1154969947 | Lori Kristen Miracle | Acupuncturist | Kwan Yin Healing Arts Center East Inc, 3115 Ne Sandy Blvd. Suite 231, Portland, OR 97232 | 2019-12-12 |
| 1194285411 | Onampai Modina Soondarotok | Student in an Organized Health Care Education/Training Program | Ipp, Oregon Health & Science University, 2214 Lloyd Center, Portland, OR 97232 | 2019-03-22 |
| 1003399635 | Cathleen Nicole Wenberg | Social Worker | 1839 Ne Couch St, Portland, OR 97232 | 2018-09-10 |
| 1508350760 | Float North | Acupuncturist | 1617 Ne 17th Ave., Portland, OR 97232 | 2018-06-20 |
| 1629560719 | Rachael Lee Walters | Doula | 3005 Ne Hoyt St, Portland, OR 97232 | 2018-06-04 |
| 1225529431 | Jason Sutherland | Social Worker | 707 Ne Couch, Portland, OR 97232 | 2018-05-23 |
| 1770089245 | Richard Farwell Leman | Family Medicine | 800 Ne Oregon St., Suite 772, Portland, OR 97232 | 2018-04-03 |
| 1952803413 | Aleksandra Giedowyn Md PC | Family Medicine | 1923 Ne Broadway Street Suite 2, Portland, OR 97232 | 2018-03-01 |
| 1639680374 | Amanda Matteo | Counselor | 20 Ne 10th Ave, Portland, OR 97232 | 2017-10-20 |
| Find all providers in zip 97232 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356662845 | Baber Nazir Khatib | Dentist | 1849 Nw Kearney St Ste 300, Portland, OR 97209-1453 | 2010-06-18 |
| 1780728998 | Normund Karl Auzins | Dentist | 3549 N Lombard St, Portland, OR 97217-5901 | 2007-02-19 |
| 1962412312 | Steven Wayne Beadnell | Dentist | 11786 Sw Barnes Rd Ste 110, Portland, OR 97225-5926 | 2006-08-08 |
| 1639103658 | Columbia Park Oral Surgery PC | Dentist | 3549 N Lombard, Portland, OR 97217-5901 | 2006-07-10 |
| 1881674042 | Kim K Erickson | Dentist | 511 10th Ave Suite 808, Portland, OR 97205-4661 | 2006-01-21 |
| 1871571711 | Daniel Joseph Traub | Dentist | 131 Johnson Rd Suite 3, Portland, ME 04102 | 2006-01-01 |
| 1972588374 | Julie Ann Smith | Dentist | 8931 Se Foster Rd, Portland, OR 97266-4661 | 2005-12-08 |
| 1952717084 | Maine Coast Oral Surgery | Dentist | 1601 Congress St, Portland, ME 04102-2102 | 2014-07-09 |
| 1740695527 | Adam Peter Fagin | Dentist | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2014-06-30 |
| 1073928289 | Nadir Elias | Dentist | 1849 Nw Kearney St Ste 300, Portland, OR 97209-1453 | 2014-06-25 |
| Find all providers in PORTLAND | ||||
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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.