Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 2901012852 | MI |
N | 204E00000X | Oral & Maxillofacial Surgeon | 2901012852 | MI |
NPI | 1083718613 |
---|---|
Provider Name | Dr. David H Sturtz |
First Address | Plymouth, MI 48170-4183 |
Second Address | Plymouth, MI 48170-4157 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2006 |
Last Update Date | 23/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DS012852 | BCBS IDENTIFIER (01) | MI |
U21487 | (02) | MI |