Provider Demographics
NPI:1275743171
Name:MICHAEL D. STERN D.D.S., INC.
Entity Type:Organization
Organization Name:MICHAEL D. STERN D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-975-8444
Mailing Address - Street 1:34950 CHARDON RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9162
Mailing Address - Country:US
Mailing Address - Phone:440-975-8444
Mailing Address - Fax:440-975-2224
Practice Address - Street 1:34950 CHARDON RD
Practice Address - Street 2:SUITE 209
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-9162
Practice Address - Country:US
Practice Address - Phone:440-975-8444
Practice Address - Fax:440-975-2224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30014162261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental