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General NPI Number Information
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NPI Number | 1851655146
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Entity Type | Organization
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Legal Business Name | PAYNE & BOATNER DDS PC
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Dates
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Enumeration Date | 07/02/2012
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Last Update Date | 07/06/2022
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Provider Practice Location Address
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Address Line | 1760 RUFE SNOW DR
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City | KELLER
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State | TX
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Zip | 76248-5628
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Country | US
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Telephone | 817-498-3889
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Fax | 817-281-2810
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Provider Business Mailing Address
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Address Line | 1760 RUFE SNOW DR
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City | KELLER
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State | TX
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Zip | 76248-5628
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GLENN M PAYNE
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Credential | DDS
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Telephone | 817-498-3889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 20864
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License Number State | TX
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