Provider Demographics
NPI:1073808051
Name:STURM, MICHELLE NICOLE (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:NICOLE
Last Name:STURM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:NICOLE
Other - Last Name:EISCHEID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:822 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-2360
Mailing Address - Country:US
Mailing Address - Phone:712-792-2528
Mailing Address - Fax:
Practice Address - Street 1:822 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-2360
Practice Address - Country:US
Practice Address - Phone:712-792-2528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA088211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice