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General NPI Number Information
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NPI Number | 1306968342
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Entity Type | Individual
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Provider Name | MICHAEL D. PAYNE D.M.D., P.C.
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Gender | Male
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 3289 N TOWERBRIDGE WAY
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City | MERIDIAN
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State | ID
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Zip | 83642-8347
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Country | US
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Telephone | 208-884-4466
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Fax | 208-884-3023
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Provider Business Mailing Address
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Address Line | 3289 N TOWERBRIDGE WAY
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City | MERIDIAN
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State | ID
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Zip | 83642-8347
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Country | US
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Telephone | 208-884-4466
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Fax | 208-884-3023
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D-3735-OR
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License Number State | ID
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