Provider Demographics
NPI:1821283995
Name:STERNER, TRAVIS RANDALL (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:RANDALL
Last Name:STERNER
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 1:156 BARKER RD
Mailing Address - Street 2:PO BOX 339
Mailing Address - City:WHITMORE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48189-9507
Mailing Address - Country:US
Mailing Address - Phone:734-449-2081
Mailing Address - Fax:734-449-2083
Practice Address - Street 1:156 BARKER RD
Practice Address - Street 2:
Practice Address - City:WHITMORE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48189-9507
Practice Address - Country:US
Practice Address - Phone:734-449-2081
Practice Address - Fax:734-449-2083
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI192941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice