Provider Demographics
NPI:1598968042
Name:STURN, IAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:
Last Name:STURN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10010 HIGHWAY 92
Mailing Address - Street 2:SUITE 140
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-6427
Mailing Address - Country:US
Mailing Address - Phone:770-517-2688
Mailing Address - Fax:
Practice Address - Street 1:10010 HIGHWAY 92
Practice Address - Street 2:SUITE 140
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-6427
Practice Address - Country:US
Practice Address - Phone:770-517-2688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11307122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist