Provider Demographics
NPI:1023192614
Name:CLAYBON, STEPHEN L (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:L
Last Name:CLAYBON
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 1:12004 TIMBERLAKE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-1332
Mailing Address - Country:US
Mailing Address - Phone:513-489-6322
Mailing Address - Fax:
Practice Address - Street 1:285 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-3072
Practice Address - Country:US
Practice Address - Phone:513-732-0541
Practice Address - Fax:513-732-0552
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0143901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0280280Medicaid