Provider Demographics
NPI:1821149246
Name:STERN, SYLVAN S (DDS)
Entity Type:Individual
Prefix:DR
First Name:SYLVAN
Middle Name:S
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 1:14720 LORETTA PL
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1016
Mailing Address - Country:US
Mailing Address - Phone:248-559-0995
Mailing Address - Fax:248-559-6724
Practice Address - Street 1:17040 W 12 MILE RD
Practice Address - Street 2:#150
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2131
Practice Address - Country:US
Practice Address - Phone:248-559-0995
Practice Address - Fax:248-559-6724
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI128821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6707290001Medicare NSC