Provider Demographics
NPI:1902878549
Name:HAMILTON, STEPHEN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:D
Last Name:HAMILTON
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 1:74 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-4717
Mailing Address - Country:US
Mailing Address - Phone:937-879-9628
Mailing Address - Fax:
Practice Address - Street 1:74 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-4717
Practice Address - Country:US
Practice Address - Phone:937-879-9628
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16064OH1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH16064OHOtherSTATE DENTAL LICENSE