Provider Demographics
NPI:1053920132
Name:DENTISTRY FOR NORTHERN MICHIGAN PLLC
Entity type:Organization
Organization Name:DENTISTRY FOR NORTHERN MICHIGAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:STERNHAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-735-3624
Mailing Address - Street 1:932 E EIGHTH ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-2750
Mailing Address - Country:US
Mailing Address - Phone:231-947-8586
Mailing Address - Fax:231-947-8115
Practice Address - Street 1:932 E EIGHTH ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2750
Practice Address - Country:US
Practice Address - Phone:231-947-8586
Practice Address - Fax:231-947-8115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1114906328Medicaid