Provider Demographics
NPI:1154640787
Name:PAYNE, SUSANNAH RULE (DDS)
Entity Type:Individual
Prefix:MS
First Name:SUSANNAH
Middle Name:RULE
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 1:1717 N 35TH ST
Mailing Address - Street 2:APT 8
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-9048
Mailing Address - Country:US
Mailing Address - Phone:210-386-9272
Mailing Address - Fax:
Practice Address - Street 1:4118 MCCULLOUGH AVE STE 14
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-1905
Practice Address - Country:US
Practice Address - Phone:210-824-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-21
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31134122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist