Healthcare Provider Details

I. General information

NPI: 1801800057
Provider Name (Legal Business Name): MYRON M STERNSTEIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

997 CLOCK TOWER DR SUITE B
SPRINGFIELD IL
62704-1301
US

IV. Provider business mailing address

997 CLOCK TOWER DR SUITE B
SPRINGFIELD IL
62704-1301
US

V. Phone/Fax

Practice location:
  • Phone: 217-546-9600
  • Fax: 217-546-9642
Mailing address:
  • Phone: 217-546-9600
  • Fax: 217-546-9642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: