Provider Demographics
NPI:1972578987
Name:PAYNE, WILLIAM MARVIN (DDS)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MARVIN
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:PO BOX 964
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-0964
Mailing Address - Country:US
Mailing Address - Phone:620-241-0266
Mailing Address - Fax:620-241-6061
Practice Address - Street 1:1325 E 1ST ST
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-3601
Practice Address - Country:US
Practice Address - Phone:620-241-0266
Practice Address - Fax:620-241-6061
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS55631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS8998OtherBCBS PROVIDER NUMBER
KS5563OtherLISCENSE NUMBER
KS888167OtherUNITED CONCORIDA PROVIDER