Provider Demographics
NPI:1407385719
Name:STURM, ETHAN JEFFREY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:JEFFREY
Last Name:STURM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BANKS PL UNIT 309
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-6152
Mailing Address - Country:US
Mailing Address - Phone:732-606-2391
Mailing Address - Fax:
Practice Address - Street 1:160 RODNEY FRENCH BLVD
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02744-1640
Practice Address - Country:US
Practice Address - Phone:508-717-3977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18575941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice