JERRY L SULLIVAN DDS
NPI 1093929044
Dentist - General Practice in Kingman, AZ

Q: What is Jerry Sullivan's NPI number?

The NPI number for Jerry Sullivan is 1093929044. It was assigned to this individual provider in the NPPES registry on May 9, 2007.

Q: What is Jerry Sullivan's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Q: When was this NPI record last updated?

The NPPES record for Jerry Sullivan was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since May 09, 2007

411 GRANDVIEW AVE, KINGMAN, AZ 86401(928) 753-6611(928) 753-1288 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Jerry L Sullivan Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JERRY L SULLIVAN DDS (NPI 1093929044) is an individual general practice provider in Kingman, Arizona, licensed in Arizona (3296) and active in the NPI registry since May 2007.

NPPES Registry Identity

NPI1093929044

Entity TypeIndividualMale

Primary Taxonomy1223G0001X

Provider Legal NameJERRY L SULLIVANCredential: DDS

Location Address411 GRANDVIEW AVEKingman, AZ 86401-5745

Mailing Address411 Grandview AveKingman, AZ 86401-5745 · (928) 753-6611 · Fax (928) 753-1288

Phone(928) 753-6611

Fax(928) 753-1288

Sole ProprietorYes

Enumeration DateMay 9, 2007

Last NPPES UpdateJuly 8, 2007

✔ NPI 1093929044 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

License✔ Licensed in AZ · 3296

Definition

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.

411 GRANDVIEW AVE, Kingman, AZ 86401

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and more.Insurance ›

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jerry Sullivan's NPI number?

The NPI number for Jerry Sullivan is 1093929044. It was assigned to this individual provider in the NPPES registry on May 9, 2007.

Where is Jerry Sullivan located?

Jerry Sullivan practices at 411 Grandview Ave, Kingman, AZ 86401. The listed phone number is (928) 753-6611.

What is Jerry Sullivan's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

What insurance does Jerry Sullivan accept?

Health plans from Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and Delta Dental of Arizona list Jerry Sullivan as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jerry Sullivan was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.