Provider Demographics
NPI:1023126109
Name:R E STERNS III DDS INC
Entity type:Organization
Organization Name:R E STERNS III DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:R
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:361-643-9557
Mailing Address - Street 1:101 CEDAR DR
Mailing Address - Street 2:STE B
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-2935
Mailing Address - Country:US
Mailing Address - Phone:361-643-9557
Mailing Address - Fax:361-643-2700
Practice Address - Street 1:101 CEDAR DR
Practice Address - Street 2:STE B
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-2935
Practice Address - Country:US
Practice Address - Phone:361-643-9557
Practice Address - Fax:361-643-2700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18635122300000X
TX7565122300000X
TX16461122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX817979OtherUNITED CONCORDIA
TX820261OtherBLUE CROSS BLUE SHIELD
TX820262OtherBLUE CROSS BLUE SHIELD
820263OtherBLUE CROSS BLUE SHIELD