MEDICARE: DR. MICHAEL L STURGEON JR. DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	9080	KY

General Provider Information

NPI Number	:	1952697997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL L STURGEON JR. DMD

Provider Business Mailing Address
First Line	:	6505 DOWNS BRANCH RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40228-1314
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 MIDDLETOWN PARK PL
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40243-2514
Country	:	US
Telephone Number	:	502-253-0008
Fax Number	:	502-253-0039

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2011
Last Update Date	:	06/28/2012

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