Provider Demographics
NPI:1063552172
Name:PAYANT, JOHN ROBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:PAYANT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2058 E GRAND AVE
Mailing Address - Street 2:SUITE 15
Mailing Address - City:LINDENHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60046-9058
Mailing Address - Country:US
Mailing Address - Phone:847-356-7400
Mailing Address - Fax:847-356-7400
Practice Address - Street 1:2058 E GRAND AVE
Practice Address - Street 2:SUITE 15
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046-9058
Practice Address - Country:US
Practice Address - Phone:847-356-7400
Practice Address - Fax:847-356-7400
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist