Provider Demographics
NPI:1689796575
Name:STURMAN, IRA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:M
Last Name:STURMAN
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 1:14204 BAYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-2331
Mailing Address - Country:US
Mailing Address - Phone:718-939-7700
Mailing Address - Fax:718-939-8898
Practice Address - Street 1:14204 BAYSIDE AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-2331
Practice Address - Country:US
Practice Address - Phone:718-939-7700
Practice Address - Fax:718-939-8898
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0312831223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00293114Medicaid
NY00293114Medicaid
NY43007Medicare ID - Type Unspecified