Healthcare Provider Details

I. General information

NPI: 1972578987
Provider Name (Legal Business Name): WILLIAM MARVIN PAYNE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 E 1ST ST
MCPHERSON KS
67460-3601
US

IV. Provider business mailing address

PO BOX 964
MCPHERSON KS
67460-0964
US

V. Phone/Fax

Practice location:
  • Phone: 620-241-0266
  • Fax: 620-241-6061
Mailing address:
  • Phone: 620-241-0266
  • Fax: 620-241-6061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5563
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: