Provider Demographics
NPI:1023767746
Name:MICHAEL L STURGEON DMD PSC
Entity type:Organization
Organization Name:MICHAEL L STURGEON DMD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:STURGEON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-448-8354
Mailing Address - Street 1:4040 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-3875
Mailing Address - Country:US
Mailing Address - Phone:502-448-8354
Mailing Address - Fax:502-448-4708
Practice Address - Street 1:4040 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-3875
Practice Address - Country:US
Practice Address - Phone:502-448-8354
Practice Address - Fax:502-448-4708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental