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General NPI Number Information
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NPI Number | 1578689659
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Entity Type | Organization
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Legal Business Name | PAYNTER FAMILY DENTISTRY, PC
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 445 W POWELL BLVD
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City | GRESHAM
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State | OR
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Zip | 97030-7048
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Country | US
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Telephone | 503-666-7000
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Fax | 503-669-2080
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Provider Business Mailing Address
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Address Line | 445 W POWELL BLVD
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City | GRESHAM
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State | OR
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Zip | 97030-7048
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Country | US
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Telephone | 503-666-7000
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Fax | 503-669-2080
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MITCHELL M PAYNTER
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Credential | DMD
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Telephone | 503-666-7000
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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 | D8720
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License Number State | OR
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