STACY LYNN SULLIVAN DDS Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

LICENSED SPECIALIST IN DENTISTRY

License Number

021002489

License Status

INACTIVE

Business

First Name

STACY

Middle

LYNN

Last Name

SULLIVAN

Suffix

DDS

Business Name

STACY LYNN SULLIVAN DDS

Original Issue Date

09/07/2012

Effective Date

07/22/2015

Expiration Date

09/30/2018

City

BIRMINGHAM

State

Zip

48009

County

MICHIGAN

Specialty/Qualifier

PEDIATRIC DENTISTRY

Ever Disciplined

LastModifiedDate

06/07/2018