Provider Demographics
NPI:1679608475
Name:G A STERMER JR., DDS LLC
Entity Type:Organization
Organization Name:G A STERMER JR., DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:STERMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:276-638-3265
Mailing Address - Street 1:PO BOX 5226
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24115-5226
Mailing Address - Country:US
Mailing Address - Phone:276-638-3265
Mailing Address - Fax:276-656-1190
Practice Address - Street 1:5 DUDLEY ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-1905
Practice Address - Country:US
Practice Address - Phone:276-638-3265
Practice Address - Fax:276-656-1190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010034311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========OtherFEDERAL TAX ID NUMBER