Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 44780 | CA |
NPI | 1003044496 |
---|---|
Provider Name | Gregory Abraham Stern |
First Address | Westwood, CA 90024 |
Second Address | Westwood, CA 90024 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2009 |
Last Update Date | 13/06/2016 |