Individual provider Active NPI

David Biford Sturgeon, D.D.S.

  • General Practice Dentistry
  • Kokomo, IN
National Provider Identifier
1568569275
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12006858A Issued in IN
Practice address
3905 Southland Ave
Suite B
Kokomo, IN 46902-3864
Phone
(765) 455-0875
Fax
(765) 455-2590
NPI assigned
Sep 17, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 12006858A IN Primary

Addresses

Primary practice location

3905 Southland Ave
Suite B
Kokomo, IN 46902-3864

Mailing address

3905 Southland Ave
Suite B
Kokomo, IN 46902-3864
Phone (765) 455-0875

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170111003329 IN Order and Referring Only - DentistPractitioner - Dentist 7517248271

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12006858AINMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1568569275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3905 SOUTHLAND AVE",
            "address_2": "SUITE B",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469023864",
            "telephone_number": "765-455-0875",
            "fax_number": "765-455-2590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3905 SOUTHLAND AVE",
            "address_2": "SUITE B",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469023864",
            "telephone_number": "765-455-0875",
            "fax_number": "765-455-2590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STURGEON",
        "first_name": "DAVID",
        "middle_name": "BIFORD",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12006858A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kokomo, IN

Sources for this page

Verify at the official NPI Registry.