Provider Demographics
NPI:1164462198
Name:PAYNE, ROBERT CRAIG (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CRAIG
Last Name:PAYNE
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:2093 STICKLEY DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6490
Mailing Address - Country:US
Mailing Address - Phone:616-949-5185
Mailing Address - Fax:616-942-0170
Practice Address - Street 1:1179 E PARIS AVE SE
Practice Address - Street 2:SUITE 130
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3682
Practice Address - Country:US
Practice Address - Phone:616-942-9840
Practice Address - Fax:616-942-0170
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI103541223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry