Provider Demographics
NPI:1871703769
Name:STERN, MICHAEL DAVID (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
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 1:34500 CHARDON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44094-8239
Mailing Address - Country:US
Mailing Address - Phone:440-975-8444
Mailing Address - Fax:440-975-2224
Practice Address - Street 1:34500 CHARDON RD STE 1
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44094-8239
Practice Address - Country:US
Practice Address - Phone:440-975-8444
Practice Address - Fax:440-833-4453
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.014162332B00000X
OH300141621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies