| NPI | 1104029347 |
|---|---|
| Former Name | TAMMY L STURDEVANT |
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D12405) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D12405) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2024-07-15 |