Provider Demographics
NPI:1750760807
Name:STERN, DANIEL DAVID (DDS)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:DAVID
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 1:122 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1932
Mailing Address - Country:US
Mailing Address - Phone:917-757-2790
Mailing Address - Fax:
Practice Address - Street 1:122 HARRISON ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1932
Practice Address - Country:US
Practice Address - Phone:917-757-2790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0580861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04225509Medicaid