Provider Demographics
NPI:1003908104
Name:RAYBURN, STEPHEN PAUL (DDS MSPC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PAUL
Last Name:RAYBURN
Suffix:
Gender:M
Credentials:DDS MSPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2831 W PARKER ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-7936
Mailing Address - Country:US
Mailing Address - Phone:972-867-6117
Mailing Address - Fax:972-964-0407
Practice Address - Street 1:2831 W PARKER RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-7936
Practice Address - Country:US
Practice Address - Phone:972-867-6117
Practice Address - Fax:972-964-0407
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics