DR. ANDREA LEE SULLIVAN (NPI# 1871092502) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871092502 |
| Entity Type | Individual |
| Full Name | DR. ANDREA LEE SULLIVAN |
| Credential | DMD |
| Practice Address |
3024 South Il-159 Glen Carbon IL 62034 |
| Mailing Address |
902 Monterey Dr O Fallon IL 62269-2833 |
| Practice Telephone | 8555792158 |
| Mailing Telephone | 6189757454 |
| Enumeration Date | 2018-02-08 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
2018003588 | MO | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | MISSOURI DENTAL BOARD | 2018003588 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1200 Big Bill Rd, Arnold, MO 630102117 | 6369252129 | |
| 1809 Homer M Adams Pkwy Ste A, Alton, IL 620025606 | 8442190605 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033526868 | Andrea Michelle Sullivan | Home Health Aide | 6340 Wall St., Ravenna, OH 44266 | 2014-07-14 |
| 1891048005 | Andrea D Sullivan | Naturopath | 4601 Connecticut Ave Northwest, Washington, DC 20008-4572 | 2012-10-25 |
| 1255605150 | Andrea Sullivan | Social Worker | 156 5th Ave Ste 1114, New York, NY 10010 | 2012-02-24 |
| 1619297694 | Andrea Marie Sullivan | Massage Therapist | 2150 Saint Anthony Ave, Saint Paul, MN 55104-5029 | 2010-06-01 |
| 1265496905 | Andrea N Sullivan | Internal Medicine | 3535 Garrett Dr, Santa Clara, CA 95054-2811 | 2006-04-12 |
| 1558908426 | Andrea Sullivan | Occupational Therapist | 785 Mamaroneck Ave, White Plains, NY 10605-2523 | 2019-12-10 |
| 1548763964 | Andrea Sullivan | Behavioral Analyst | 1900 Embarcadero Ste 310, Oakland, CA 94606-5227 | 2018-03-12 |
| 1023392602 | Andrea Renee Sullivan | Pharmacist | 2101 Richard Arrington Jr Blvd S, Birmingham, AL 35209-1256 | 2011-09-30 |
| 1831410547 | Andrea Leigh Sullivan | Social Worker | 1007 W Mitchell St, Ste 102, Arlington, TX 76013-2508 | 2010-06-16 |
| 1477710291 | Andrea Kaye Sullivan | Counselor | 2409 Homer Clayton Dr, Guntersville, AL 35976-2207 | 2008-05-20 |
| Street Address |
3024 SOUTH IL-159 |
| City | GLEN CARBON |
| State | IL |
| Zip Code | 62034 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740787795 | Kaleena Galletta | Nurse Practitioner | 4273 S., Il - 159, Glen Carbon, IL 62034 | 2018-04-06 |
| 1417464918 | Stages Health & Wellness, LLC | Nurse Practitioner | 14 Crabapple Lane, Glen Carbon, IL 62034 | 2018-01-05 |
| 1700300498 | Michael Jay Arnold | Dentist | 3024 Il-159, Glen Carbon, IL 62034 | 2017-08-03 |
| 1679024228 | 360 Body Wellness Inc | Internal Medicine | 3407 Il State Route 157, Glen Carbon, IL 62034 | 2016-10-19 |
| 1346621505 | Stephanie N Lorts | Pediatrics | 4804 South State Route 159, Glen Carbon, IL 62034 | 2015-06-13 |
| 1205110111 | James Allan Staley | Pharmacist | #2 Cottonwood Rd, Glen Carbon, IL 62034 | 2011-10-11 |
| 1215224357 | Angela Eleni Kioultzopoulos | Speech-Language Pathologist | 7a Ginger Creek Village Dr., Glen Carbon, IL 62034 | 2011-07-08 |
| 1922320795 | Meridian Village Association | Skilled Nursing Facility | 27 Auerbach Place, Glen Carbon, IL 62034 | 2010-02-22 |
| 1679728356 | Erin Kathleen Immken | Counselor | 98 Junction Drive West, Suite 6, Glen Carbon, IL 62034 | 2008-11-24 |
| 1689886681 | Dental Professionals of Illinois, P.C. | Dentist | 4235 S State Road 159, Glen Carbon, IL 62034 | 2007-05-04 |
| Find all providers in zip 62034 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700300498 | Michael Jay Arnold | Dentist | 3024 Il-159, Glen Carbon, IL 62034 | 2017-08-03 |
| 1679783583 | Todd M Brammeier | Dentist | 450 Cottonwood Rd, Suite A, Glen Carbon, IL 62034-2772 | 2007-05-23 |
| 1689886681 | Dental Professionals of Illinois, P.C. | Dentist | 4235 S State Road 159, Glen Carbon, IL 62034 | 2007-05-04 |
| 1487714499 | Keith Andrew Bryant | Dentist | 4224 S State Route 159, Suite 1, Glen Carbon, IL 62034-3201 | 2006-12-11 |
| 1790799385 | Poonam Jain | Dentist | 24 Ginger Creek Pkwy, Glen Carbon, IL 62034-3502 | 2006-07-28 |
| 1184232340 | Seghen Amanios | Dentist | 3024 S State Route 159, Glen Carbon, IL 62034-3109 | 2020-07-14 |
| 1689218430 | The Center for Complete Health Dentistry | Dentist | 590 Glen Crossing Rd, Glen Carbon, IL 62034-1519 | 2019-11-05 |
| 1023448891 | West End Family Dental | Dentist | 24 Ginger Creek Pkwy, Glen Carbon, IL 62034-3502 | 2013-11-15 |
| 1023323623 | Ginger Creek Dental LLC | Dentist | 24 Ginger Creek Pkwy, Glen Carbon, IL 62034-3502 | 2010-08-09 |
| 1770741183 | Briana L. Oller, D.m.d., P.C. | Dentist | 25 Glen Ed Professional Park, Glen Carbon, IL 62034-3333 | 2008-06-02 |
| Find all providers in GLEN CARBON | ||||
| City | GLEN CARBON |
| Zip Code | 62034 |
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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.