MEDICARE: DR. MITCHELL MATTHEW PAYNTER DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DE00009544	WA

General Provider Information

NPI Number	:	1437137569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MITCHELL MATTHEW PAYNTER DMD

Provider Business Mailing Address
First Line	:	1419 OAKES AVE
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98201-1630
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	NAVAL HOSPITAL OAK HARBOR NAS WHIDBEY ISLAND
Second Line	:	3475 N. SARATOGA ST
City	:	OAK HARBOR
State	:	WA
Zip	:	98278-0001
Country	:	US
Telephone Number	:	360-257-2301
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	07/08/2007

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