MEDICARE: EMILY PROCTOR PAYNE D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	9443	NC

General Provider Information

NPI Number	:	1366544918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY PROCTOR PAYNE D.D.S

Provider Business Mailing Address
First Line	:	7252 GB ALFORD HWY
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-7661
Country	:	US
Telephone Number	:	919-600-6262
Fax Number	:

Provider Business Practice Location Address
First Line	:	7252 GB ALFORD HWY
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-7661
Country	:	US
Telephone Number	:	919-600-6262
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2006
Last Update Date	:	02/13/2013

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