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General NPI Number Information
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NPI Number | 1184921082
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Entity Type | Organization
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Legal Business Name | PAYNE DENTAL CORPORATION
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Dates
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Enumeration Date | 02/11/2011
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Last Update Date | 02/11/2011
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Provider Practice Location Address
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Address Line | 250 BLOSSOM HILL RD SUITE 100
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City | LOS GATOS
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State | CA
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Zip | 95032-4400
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Country | US
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Telephone | 408-912-7555
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Fax | 408-782-2205
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Provider Business Mailing Address
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Address Line | 6236 OMAHA CT
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City | SAN JOSE
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State | CA
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Zip | 95123-5521
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Country | US
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Telephone | 408-912-7555
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Fax |
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Authorized Official
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Title or Position | DENTIST/ PRESIDENT
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Name | DR. MARTHA CATALINA PAYNE
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Credential | D.M.D.
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Telephone | 408-912-7555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 59792
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License Number State | CA
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