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General NPI Number Information
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NPI Number | 1619375714
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Entity Type | Organization
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Legal Business Name | WILLIAM H PAYNE DDS LLC
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Dates
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Enumeration Date | 12/05/2014
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Last Update Date | 12/05/2014
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Provider Practice Location Address
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Address Line | 411 S MAIN ST
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City | RED LION
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State | PA
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Zip | 17356-2412
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Country | US
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Telephone | 717-246-1085
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Fax | 717-246-4472
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Provider Business Mailing Address
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Address Line | 411 S MAIN ST
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City | RED LION
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State | PA
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Zip | 17356-2412
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Country | US
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Telephone | 717-246-1085
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Fax | 717-246-4472
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | WILLIAM H PAYNE
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Credential | DDS
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Telephone | 717-246-1085
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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 | DS018151L
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License Number State | PA
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