Healthcare Provider Details

I. General information

NPI: 1780656991
Provider Name (Legal Business Name): MICHAEL HOWARD PAYNE D.D.S.,M.S.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3406 AMERICAN RIVER DR SUITE E
SACRAMENTO CA
95864-5746
US

IV. Provider business mailing address

3406 AMERICAN RIVER DR SUITE E
SACRAMENTO CA
95864-5746
US

V. Phone/Fax

Practice location:
  • Phone: 916-486-4233
  • Fax: 916-486-3626
Mailing address:
  • Phone: 916-486-4233
  • Fax: 916-486-3626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number36819
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: