Provider Demographics
NPI:1205009990
Name:PAYNE, LANNY SCOTT (DDS)
Entity Type:Individual
Prefix:
First Name:LANNY
Middle Name:SCOTT
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 1:285 N EL CAMINO REAL
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5383
Mailing Address - Country:US
Mailing Address - Phone:760-753-7700
Mailing Address - Fax:760-753-7747
Practice Address - Street 1:285 N EL CAMINO REAL
Practice Address - Street 2:SUITE # 102
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5383
Practice Address - Country:US
Practice Address - Phone:760-753-7700
Practice Address - Fax:760-753-7747
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA278171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice