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

Individual provider Oral and Maxillofacial Surgery (Dentist) · NPI 1972134567

Scott R Sullivan, DDS, MD is a Maxillofacial Surgery in Springfield, Missouri. Graduated from University of Missouri, Kansas City, School of Medicine in 2020, 6 years ago. Licensed in Missouri.

Years since qualifying
6
Trained at
University of Missouri, Kansas City, School of Medicine
Licensed in
MO
In the registry since
2020
What do these letters mean?
DDS — Doctor of Dental Surgery
A dentist. DDS and DMD are the same qualification — universities choose which title to award.
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1103 E Montclair St
Springfield, MO 65807-5076
Phone: (316) 616-8157
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Oral and Maxillofacial Surgery (Dentist) (primary) Taxonomy 1223S0112X · Licence 2025018574 (MO)

Record details

NPI number1972134567
Entity typeIndividual (Type 1)
GenderMale
Credentials DDS , MD
Sole proprietorNo
NPI enumeratedFebruary 1, 2020
Last updated in NPPESFebruary 18, 2026
Certification dateFebruary 18, 2026
Mailing address4649 Cole Ave Apt 116, Dallas, TX 75205-4043

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMAXILLOFACIAL SURGERY
Also practisesDENTIST
Medical schoolUNIVERSITY OF MISSOURI, KANSAS CITY, SCHOOL OF MEDICINE
Graduated 2020 (6 years in practice)
Accepts Medicare assignment Not indicated

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