Active NPI
Michael Derek Sturt, D.D.S.
- General Practice Dentistry
- McHenry, IL
National Provider Identifier
1336152966
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- Practice address
- 5400 W Elm St
Ste 212
McHenry, IL 60050-4010 - Phone
- (815) 578-1000
- Fax
- (815) 578-1229
- NPI assigned
- Aug 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | IL | Primary |
Addresses
Primary practice location
5400 W Elm St
Ste 212
McHenry, IL 60050-4010
Mailing address
8 Washitay Ave
Hawthorn Woods, IL 60047-1925
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019-024306 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1336152966",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8 WASHITAY AVE",
"city": "HAWTHORN WOODS",
"state": "IL",
"postal_code": "600471925"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5400 W ELM ST",
"address_2": "STE 212",
"city": "MCHENRY",
"state": "IL",
"postal_code": "600504010",
"telephone_number": "815-578-1000",
"fax_number": "815-578-1229"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STURT",
"first_name": "MICHAEL",
"middle_name": "DEREK",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McHenry, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.