Provider Demographics
NPI:1306968342
Name:PAYNE, MICHAEL D (DMD, PC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:PAYNE
Suffix:
Gender:M
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3289 N TOWERBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8347
Mailing Address - Country:US
Mailing Address - Phone:208-884-4466
Mailing Address - Fax:208-884-3023
Practice Address - Street 1:3289 N TOWERBRIDGE WAY
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8347
Practice Address - Country:US
Practice Address - Phone:208-884-4466
Practice Address - Fax:208-884-3023
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-3735-OR1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics