Provider Demographics
NPI:1861788119
Name:PAXTON, DEAN CALEB (DDS)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:CALEB
Last Name:PAXTON
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 1:3257 SUMMERLEE ROAD
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901
Mailing Address - Country:US
Mailing Address - Phone:304-465-8705
Mailing Address - Fax:304-465-2163
Practice Address - Street 1:3257 SUMMERLEE ROAD
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901
Practice Address - Country:US
Practice Address - Phone:304-465-8705
Practice Address - Fax:304-465-2163
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV39581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810020737Medicaid
WVWV0259BMedicare PIN
WV3810020737Medicaid