Provider Demographics
NPI:1104029347
Name:STURDEVANT, TAMMY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:L
Last Name:STURDEVANT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 4TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:PERHAM
Mailing Address - State:MN
Mailing Address - Zip Code:56573
Mailing Address - Country:US
Mailing Address - Phone:218-346-7186
Mailing Address - Fax:218-346-7182
Practice Address - Street 1:335 4TH AVE
Practice Address - Street 2:
Practice Address - City:PERHAM
Practice Address - State:MN
Practice Address - Zip Code:56573
Practice Address - Country:US
Practice Address - Phone:218-346-7186
Practice Address - Fax:218-346-7182
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12405122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist