Healthcare Provider Details

I. General information

NPI: 1477951150
Provider Name (Legal Business Name): SYLVAN STERN DENTAL SLEEP MEDICINE PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2014
Last Update Date: 12/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17040 W 12 MILE RD SUITE 150
SOUTHFIELD MI
48076-2131
US

IV. Provider business mailing address

17040 W 12 MILE RD SUITE 150
SOUTHFIELD MI
48076-2131
US

V. Phone/Fax

Practice location:
  • Phone: 248-559-0995
  • Fax: 248-559-6724
Mailing address:
  • Phone: 248-559-0995
  • Fax: 248-559-6724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12882
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number12882
License Number StateMI

VIII. Authorized Official

Name: DR. SYLVAN S STERN
Title or Position: SOLE MEMBER
Credential: DDS
Phone: 248-559-0995