Provider Demographics
NPI:1689723678
Name:DURHAM, STEPHEN W (DMD, PA)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:W
Last Name:DURHAM
Suffix:
Gender:M
Credentials:DMD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 DAYTON SCHOOL RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-1447
Mailing Address - Country:US
Mailing Address - Phone:864-306-8350
Mailing Address - Fax:864-306-8587
Practice Address - Street 1:223 DAYTON SCHOOL RD
Practice Address - Street 2:SUITE 103
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-1447
Practice Address - Country:US
Practice Address - Phone:864-306-8350
Practice Address - Fax:864-306-8587
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30-034401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice