=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871383281
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAXTON NICHOLAS STERN DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2025
-----------------------------------------------------
Last Update Date | 05/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 257 W GRANVILLE ST
-----------------------------------------------------
City | SUNBURY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43074-9684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-480-2015
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7615 KESTREL WAY W
-----------------------------------------------------
City | DUBLIN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43017-8255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-371-9144
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 30.027916
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------