Healthcare Provider Details

I. General information

NPI: 1508947516
Provider Name (Legal Business Name): JEFFREY BRUCE PAYNE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 01/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40TH AND HOLDREGE STREETS ROOM 137
LINCOLN NE
68583-0740
US

IV. Provider business mailing address

40TH AND HOLDREGE STREETS UNIVERSITY DENTAL ASSOCIATES
LINCOLN NE
68583-0740
US

V. Phone/Fax

Practice location:
  • Phone: 402-472-8900
  • Fax: 402-472-0048
Mailing address:
  • Phone: 402-472-8900
  • Fax: 402-472-0048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number5764
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: