Provider Demographics
NPI:1063224418
Name:BOSTON, PAYTEN RHENAE (RDH)
Entity type:Individual
Prefix:
First Name:PAYTEN
Middle Name:RHENAE
Last Name:BOSTON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4935 MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-2736
Mailing Address - Country:US
Mailing Address - Phone:615-302-1414
Mailing Address - Fax:
Practice Address - Street 1:4935 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2736
Practice Address - Country:US
Practice Address - Phone:615-302-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8949124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist