Provider Demographics
NPI:1134315344
Name:STERLING MEDICAID SERVICES LLC
Entity Type:Organization
Organization Name:STERLING MEDICAID SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STERLING
Authorized Official - Middle Name:H
Authorized Official - Last Name:STALDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-728-1278
Mailing Address - Street 1:PO BOX 891330
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73189-1330
Mailing Address - Country:US
Mailing Address - Phone:405-728-1278
Mailing Address - Fax:405-720-2441
Practice Address - Street 1:6510 S WESTERN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-1712
Practice Address - Country:US
Practice Address - Phone:405-634-7303
Practice Address - Fax:405-634-7868
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STALDER INVESTMENTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty