Provider Demographics
NPI:1043371339
Name:STURKIE, MICHAEL WAYNE JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WAYNE
Last Name:STURKIE
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3901 EDMUND HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29170-1944
Mailing Address - Country:US
Mailing Address - Phone:803-755-3953
Mailing Address - Fax:803-755-6903
Practice Address - Street 1:3901 EDMUND HWY
Practice Address - Street 2:SUITE C
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29170-1944
Practice Address - Country:US
Practice Address - Phone:803-755-3953
Practice Address - Fax:803-755-6903
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC3865122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist