Provider Demographics
NPI:1467627752
Name:DIRK A. STERLEY, D.D.S., INC
Entity type:Organization
Organization Name:DIRK A. STERLEY, D.D.S., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIRK
Authorized Official - Middle Name:A
Authorized Official - Last Name:STERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-251-1333
Mailing Address - Street 1:6545 CARROLLTON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-1787
Mailing Address - Country:US
Mailing Address - Phone:317-251-1333
Mailing Address - Fax:317-251-5075
Practice Address - Street 1:6545 CARROLLTON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-1787
Practice Address - Country:US
Practice Address - Phone:317-251-1333
Practice Address - Fax:317-251-5075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN7385122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1223G0001XOtherDENTIST GENERAL PRACTICE