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Jacob Sullivan — NPI 1922633080, Kirtland Afb, NM | NPI Central

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NPI 1922633080

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Jacob Sullivan

NPI 1922633080 · Dentist · Kirtland Afb, NM

Provider details

NPI number: 1922633080
Entity type: Individual
Primary specialty: DentistDental Providers
Sex: Male
Sole proprietor: No
License: D010709 (AZ)

Specialties & taxonomies

DentistPrimary122300000XLicense D010709 (AZ)
Dental Providers

Practice location

2050a 2nd St Se

Kirtland Afb, NM 87117-5522

Phone: (505) 846-3200

Approximate (ZIP-level) locationGet directions

More NM providers

Mailing address

2050a 2nd St Se

Kirtland Afb, NM 87117-5901

Registry dates

Enumerated: 2020-03-10
Last updated: 2021-09-28
Certified: 2021-09-13

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.