Provider Demographics
NPI:1770780819
Name:STURM, JACK A (DMD)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:A
Last Name:STURM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 STATE ST.
Mailing Address - Street 2:STE 8
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101
Mailing Address - Country:US
Mailing Address - Phone:805-963-9444
Mailing Address - Fax:805-963-9119
Practice Address - Street 1:1515 STATE ST.
Practice Address - Street 2:STE 8
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101
Practice Address - Country:US
Practice Address - Phone:805-963-9444
Practice Address - Fax:805-963-9119
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA459811223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics