Healthcare Provider Details

I. General information

NPI: 1649488578
Provider Name (Legal Business Name): RODNEY G PAYNE D.D.S., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3668 W 9800 S
SOUTH JORDAN UT
84095-3260
US

IV. Provider business mailing address

3668 W 9800 S
SOUTH JORDAN UT
84095-3260
US

V. Phone/Fax

Practice location:
  • Phone: 801-260-1515
  • Fax: 801-260-1691
Mailing address:
  • Phone: 801-260-1515
  • Fax: 801-260-1691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number5360696-9921
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: