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General NPI Number Information
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NPI Number | 1619079720
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Entity Type | Organization
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Legal Business Name | PAYNE&PAYNE DENTISTRY, LLC
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3015 JEFFERSON STREET SUITE D
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City | MARIANNA
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State | FL
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Zip | 32446
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Country | US
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Telephone | 850-526-2511
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Fax |
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Provider Business Mailing Address
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Address Line | 3015 JEFFERSON STREET SUITE D
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City | MARIANNA
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State | FL
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Zip | 32446
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Country | US
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Telephone | 850-526-2511
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT W. PAYNE
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Credential | D.D.S.
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Telephone | 850-526-2511
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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 | DN6254
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License Number State | FL
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