Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1093929044 Individual Practitioner Male Practitioner

Dr. Jerry L Sullivan , DDS

Dentist - General Practice • Kingman, AZ

Professional Overview & Biography Verified Profile Summary

Dr. Jerry Sullivan, DDS is a registered healthcare professional specializing in Dentist - General Practice in Kingman, AZ. Practice services are available at 411 GRANDVIEW AVE under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

411 Grandview Ave

Kingman, AZ 864015745

Telephone 9287536611
Fax 9287531288

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Kingman, AZ

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 16.4 Yrs
Regional Practice Density
16 Specialists

Practicing in Kingman, AZ (2600 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License AZ 3296

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.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
Dr. Jerald Wienke , DDS

Dentist - General Practice

NPI 1912010216

Doctor of Dental Surgery

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

📍
Updated Practice Location July 08, 2007

Registered at 411 GRANDVIEW AVE, KINGMAN, AZ 864015745 (Tel: 9287536611)

📍
Updated Business Mailing Address July 08, 2007

Registered at 411 GRANDVIEW AVE, KINGMAN, AZ 864015745 (Tel: 9287536611)

👤
Provider Name / Credentials Updated July 08, 2007

Recorded as JERRY SULLIVAN, DDS

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dentist (License #3296 in AZ)

🟢
Initial NPI Registration & Enumeration May 09, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1093929044
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: May 09, 2007
Last Update: July 08, 2007
Sole Proprietor: Yes

Mailing Address

411 Grandview Ave

Kingman, AZ 864015745

Phone: 9287536611

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.