Healthcare Provider Details

I. General information

NPI: 1760706675
Provider Name (Legal Business Name): EDYEE M STURGILL, DMD, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2010
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 WILKINSON TRCE STE B
BOWLING GREEN KY
42103-2486
US

IV. Provider business mailing address

895 WILKINSON TRCE STE B
BOWLING GREEN KY
42103-2486
US

V. Phone/Fax

Practice location:
  • Phone: 270-498-7297
  • Fax:
Mailing address:
  • Phone: 270-498-7297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number34369
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6659
License Number StateKY

VIII. Authorized Official

Name: DR. EDYEE M STURGILL
Title or Position: DOCTOR
Credential: DMD, MD
Phone: 270-498-7297