Provider Demographics
NPI:1679601975
Name:STERN, RICHARD K (DDS, PC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:K
Last Name:STERN
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5213B LYNGATE CT
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1685
Mailing Address - Country:US
Mailing Address - Phone:703-425-2494
Mailing Address - Fax:703-425-2230
Practice Address - Street 1:5213B LYNGATE CT
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1685
Practice Address - Country:US
Practice Address - Phone:703-425-2494
Practice Address - Fax:703-425-2230
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010049401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics