Provider Demographics
NPI:1144377235
Name:DURHAM, STEPHEN C (DMD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:C
Last Name:DURHAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-5228
Mailing Address - Country:US
Mailing Address - Phone:513-423-2402
Mailing Address - Fax:
Practice Address - Street 1:3606 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-5228
Practice Address - Country:US
Practice Address - Phone:513-423-2402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30015321122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist