Provider Demographics
NPI:1376644948
Name:STURGEON, SARA SUE (DDS)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:SUE
Last Name:STURGEON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:S
Other - Last Name:STURGEON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2301 EAST THIRD STREET
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-5320
Mailing Address - Country:US
Mailing Address - Phone:812-332-1406
Mailing Address - Fax:812-332-6133
Practice Address - Street 1:2301 EAST THIRD STREET
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-5320
Practice Address - Country:US
Practice Address - Phone:812-332-1406
Practice Address - Fax:812-332-6133
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007387B1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice