Provider Demographics
NPI:1790224756
Name:AVICHAI STERN DDS PLLC
Entity Type:Organization
Organization Name:AVICHAI STERN DDS PLLC
Other - Org Name:HAVEMEYER ORAL AND MAXILLOFACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AVICHAI
Authorized Official - Middle Name:
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-909-7960
Mailing Address - Street 1:161 HAVEMEYER ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-5534
Mailing Address - Country:US
Mailing Address - Phone:718-909-7960
Mailing Address - Fax:
Practice Address - Street 1:161 HAVEMEYER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-5534
Practice Address - Country:US
Practice Address - Phone:718-909-7960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051512261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery