DR. STACY ANNE SULLIVAN D.D.S. NPI 1306987631

NPI Information

NPI: 1306987631
Provider Name: DR. STACY ANNE SULLIVAN, D.D.S.
Classification: Dentist - 1223G0001X
Specialization: General Practice
Entity Type: Individual
Address: 217 E WILLOW ST
YADKINVILLE, NC
ZIP 27055
Phone: (336) 849-7777

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NPI Details

DR. Stacy Anne Sullivan, D.D.S. is a general practice dentist in Yadkinville, NC. The provider is 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. DR. Stacy Anne Sullivan, D.D.S. NPI is 1306987631. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

217 E WILLOW ST
YADKINVILLE, NC
ZIP 27055-193
Phone: (336) 849-7777

The enumeration date for this NPI number is 2/9/2007 and was last updated on 12/14/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223G0001X	Dentist	General Practice	8109	NORTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	5902245	MEDICAID	NORTH CAROLINA
2	3404399	MEDICAID	NORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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