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General NPI Number Information
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NPI Number | 1023126109
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Entity Type | Organization
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Legal Business Name | R E STERNS III DDS INC
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 101 CEDAR DR STE B
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City | PORTLAND
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State | TX
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Zip | 78374-2935
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Country | US
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Telephone | 361-643-9557
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Fax | 361-643-2700
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Provider Business Mailing Address
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Address Line | 101 CEDAR DR STE B
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City | PORTLAND
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State | TX
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Zip | 78374-2935
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Country | US
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Telephone | 361-643-9557
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Fax | 361-643-2700
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Authorized Official
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Title or Position | PRESIDENT OF CORPORATION
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Name | JENNIFER R DUNCAN
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Credential | DDS
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Telephone | 361-643-9557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 18635
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7565
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 16461
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License Number State | TX
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