JERRY L SULLIVAN

KINGMAN, AZ
NPI1093929044
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy1223G0001X Dentist, General Practice
(Licence: AZ  3296)
Enumeration Date2007-05-09
Last Update Date2007-07-08
Business Address
-- JERRY L SULLIVAN DDS
411 GRANDVIEW AVE
KINGMAN, AZ 86401-5745
Phone number: 928-753-6611
Mailing Address
-- JERRY L SULLIVAN DDS
411 GRANDVIEW AVE
KINGMAN, AZ 86401-5745
Phone number: 928-753-6611
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