Healthcare Provider Details

I. General information

NPI: 1174587315
Provider Name (Legal Business Name): KEVIN LYNN PAYTON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 S UNIVERSITY DR STE 7153
FT LAUDERDALE FL
33328-2004
US

IV. Provider business mailing address

3300 S UNIVERSITY DR STE 7153
FT LAUDERDALE FL
33328-2004
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-7153
  • Fax: 954-262-1793
Mailing address:
  • Phone: 954-262-7153
  • Fax: 954-262-1793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN11666
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: