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General NPI Number Information
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NPI Number | 1407385719
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Entity Type | Individual
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Provider Name | ETHAN JEFFREY STURM DMD
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Gender | Male
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Dates
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Enumeration Date | 06/08/2017
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Last Update Date | 06/08/2017
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Provider Practice Location Address
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Address Line | 160 RODNEY FRENCH BLVD
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City | NEW BEDFORD
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State | MA
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Zip | 02744-1640
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Country | US
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Telephone | 508-717-3977
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Fax |
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Provider Business Mailing Address
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Address Line | 2 BANKS PL UNIT 309
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City | MELROSE
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State | MA
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Zip | 02176-6152
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Country | US
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Telephone | 732-606-2391
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN1857594
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License Number State | MA
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