Provider Demographics
NPI:1396090874
Name:PAYNE, MARK JOSHUA (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOSHUA
Last Name:PAYNE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22500 SE 64TH PL STE 120
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-8111
Mailing Address - Country:US
Mailing Address - Phone:425-391-0484
Mailing Address - Fax:425-391-4002
Practice Address - Street 1:22500 SE 64TH PL STE 120
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8111
Practice Address - Country:US
Practice Address - Phone:425-391-0484
Practice Address - Fax:425-391-4002
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE607900841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice