Provider Demographics
NPI:1962428987
Name:STERN, JEFFREY LANE (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LANE
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:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:STRATHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03885
Mailing Address - Country:US
Mailing Address - Phone:603-772-3264
Mailing Address - Fax:608-418-6316
Practice Address - Street 1:157 PORTSMOUTH AVENUE
Practice Address - Street 2:
Practice Address - City:STRATHAM
Practice Address - State:NH
Practice Address - Zip Code:03885-0277
Practice Address - Country:US
Practice Address - Phone:603-772-3264
Practice Address - Fax:603-418-6316
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH1867122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30005276Medicaid