Provider Demographics
NPI:1528070422
Name:PAYNE, REX A (DDS)
Entity type:Individual
Prefix:
First Name:REX
Middle Name:A
Last Name:PAYNE
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 1:105 KATHRYN DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-4216
Mailing Address - Country:US
Mailing Address - Phone:972-221-9136
Mailing Address - Fax:972-353-3722
Practice Address - Street 1:105 KATHRYN DR
Practice Address - Street 2:SUITE A
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4216
Practice Address - Country:US
Practice Address - Phone:972-221-9136
Practice Address - Fax:972-353-3722
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX137931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice