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General NPI Number Information
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NPI Number | 1366114803
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Entity Type | Individual
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Provider Name | PAYTON RENARD DIGGINS
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Gender | Male
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Dates
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Enumeration Date | 10/04/2021
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | 450 GIBNER RD
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City | CARLISLE BARRACKS
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State | PA
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Zip | 17013-5090
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Country | US
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Telephone | 717-245-4542
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Fax |
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Provider Business Mailing Address
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Address Line | 460 SUMNER RD
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City | CARLISLE BARRACKS
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State | PA
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Zip | 17013-5091
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Country | US
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Telephone | 706-358-3060
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Fax |
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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 | 126800000X
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Taxonomy Name | Dental Assistant
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License Number |
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License Number State |
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