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General NPI Number Information
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NPI Number | 1023435823
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Entity Type | Organization
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Legal Business Name | RAKUTT AND PAYNE DENTAL PSC
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Dates
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Enumeration Date | 03/19/2014
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Last Update Date | 03/19/2014
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Provider Practice Location Address
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Address Line | 801 BARRET AVE
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City | LOUISVILLE
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State | KY
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Zip | 40204-1747
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Country | US
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Telephone | 502-582-2004
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Fax | 502-582-2032
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Provider Business Mailing Address
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Address Line | 801 BARRET AVE #107
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City | LOUISVILLE
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State | KY
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Zip | 40204-1747
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Country | US
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Telephone | 502-582-2004
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Fax | 502-582-2032
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Authorized Official
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Title or Position | OWNER
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Name | DR. SANDRA LEIGH PAYNE
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Credential | DMD
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Telephone | 502-582-2004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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