Provider Demographics
NPI:1760706675
Name:EDYEE M STURGILL, DMD, MD
Entity Type:Organization
Organization Name:EDYEE M STURGILL, DMD, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDYEE
Authorized Official - Middle Name:M
Authorized Official - Last Name:STURGILL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:270-498-7297
Mailing Address - Street 1:895 WILKINSON TRCE STE B
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-2486
Mailing Address - Country:US
Mailing Address - Phone:270-498-7297
Mailing Address - Fax:
Practice Address - Street 1:895 WILKINSON TRCE STE B
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-2486
Practice Address - Country:US
Practice Address - Phone:270-498-7297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-22
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY66591223S0112X
KY34369204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty