Healthcare Provider Details

I. General information

NPI: 1508895038
Provider Name (Legal Business Name): LOUIS G PAYOR D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LUCERNE TERRACE SUITE #100
ORLANDO FL
32806-1050
US

IV. Provider business mailing address

1573 W FAIRBANKS AVE SUITE #300
WINTER PARK FL
32789-4679
US

V. Phone/Fax

Practice location:
  • Phone: 407-843-1670
  • Fax: 407-841-1827
Mailing address:
  • Phone: 407-644-0224
  • Fax: 407-644-2827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberDN0006100
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: