Provider Demographics
NPI:1194939488
Name:SHTERN, DANIEL (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:SHTERN
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 1:222 CEDAR LN STE 305
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4313
Mailing Address - Country:US
Mailing Address - Phone:201-530-9191
Mailing Address - Fax:201-836-2996
Practice Address - Street 1:222 CEDAR LN STE 305
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4313
Practice Address - Country:US
Practice Address - Phone:201-530-9191
Practice Address - Fax:201-836-2996
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI019128001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01491661Medicaid