=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760706675
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EDYEE M STURGILL, DMD, MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2010
-----------------------------------------------------
Last Update Date | 03/16/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 895 WILKINSON TRCE STE B
-----------------------------------------------------
City | BOWLING GREEN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42103-2486
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-498-7297
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 895 WILKINSON TRCE STE B
-----------------------------------------------------
City | BOWLING GREEN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42103-2486
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-498-7297
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. EDYEE M STURGILL
-----------------------------------------------------
Credential | DMD, MD
-----------------------------------------------------
Telephone | 270-498-7297
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 204E00000X
-----------------------------------------------------
Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
-----------------------------------------------------
License Number | 34369
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 6659
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------