Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jacob Sullivan

Individual provider Dentist · NPI 1922633080

Jacob Sullivan is a Dentist in Kirtland AFB, New Mexico. Licensed in Arizona. Registered with an NPI since 2020.

Licensed in
AZ
In the registry since
2020

Practice location Address checks out

2050A 2nd St SE
Kirtland AFB, NM 87117-5522
Phone: (505) 846-3200
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence D010709 (AZ)

Record details

NPI number1922633080
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMarch 10, 2020
Last updated in NPPESSeptember 28, 2021
Certification dateSeptember 13, 2021

Other providers in Kirtland AFB