Provider Demographics
NPI:1578587713
Name:STERN, SIDNEY D (DDS)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:D
Last Name:STERN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6709
Mailing Address - Country:US
Mailing Address - Phone:718-382-1993
Mailing Address - Fax:718-382-1993
Practice Address - Street 1:1565 E 17TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6709
Practice Address - Country:US
Practice Address - Phone:718-382-1993
Practice Address - Fax:718-382-1993
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY352451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice