Healthcare Provider Details

I. General information

NPI: 1417097411
Provider Name (Legal Business Name): KIMBERLY KAY STURM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53585 NOKOMIS RD
ASHLAND WI
54806-4272
US

IV. Provider business mailing address

53585 NOKOMIS RD
ASHLAND WI
54806-4272
US

V. Phone/Fax

Practice location:
  • Phone: 715-685-7887
  • Fax: 715-685-7886
Mailing address:
  • Phone: 715-685-7887
  • Fax: 715-685-7886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number6668-15
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number10021
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: