Provider Demographics
NPI:1043259633
Name:PAYNE, GAIL A (DDS)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:A
Last Name:PAYNE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8363 CANNON KNOLL CT
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-2706
Mailing Address - Country:US
Mailing Address - Phone:513-759-0521
Mailing Address - Fax:
Practice Address - Street 1:2760 MACK RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5129
Practice Address - Country:US
Practice Address - Phone:513-874-2444
Practice Address - Fax:513-870-3064
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH164721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice