MEDICARE: CANDACE COOLEY PAYNE DMD

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	1223G0001X	General Practice Dentistry	D009144	AZ

General Provider Information

NPI Number	:	1730493099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACE COOLEY PAYNE DMD

Provider Business Mailing Address
First Line	:	31 S 63RD ST STE 5
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-1606
Country	:	US
Telephone Number	:	480-981-0203
Fax Number	:

Provider Business Practice Location Address
First Line	:	4375 1ST ST
Second Line	:
City	:	LIVERMORE
State	:	CA
Zip	:	94551-4912
Country	:	US
Telephone Number	:	925-294-9288
Fax Number	:

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

Provider Enumeration Date	:	07/28/2010
Last Update Date	:	10/22/2024

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