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General NPI Number Information
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NPI Number | 1346570215
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Entity Type | Organization
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Legal Business Name | MICHAEL J. PAYNE II, DDS. INC.
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Dates
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Enumeration Date | 12/28/2009
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Last Update Date | 12/28/2009
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Provider Practice Location Address
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Address Line | 2901 WILSHIRE BLVD STE 336
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City | SANTA MONICA
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State | CA
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Zip | 90403-4912
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Country | US
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Telephone | 310-828-4451
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Fax | 310-828-4582
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Provider Business Mailing Address
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Address Line | 2901 WILSHIRE BLVD STE 336
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City | SANTA MONICA
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State | CA
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Zip | 90403-4912
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Country | US
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Telephone | 310-828-4451
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Fax | 310-828-4582
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL JOHN PAYNE II
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Credential | DDS
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Telephone | 310-828-4451
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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 | 52912
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License Number State | CA
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