Provider Demographics
NPI:1225379571
Name:PAYNE, MICHAEL GARRETT (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GARRETT
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 1:608 N 63RD ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-4176
Mailing Address - Country:US
Mailing Address - Phone:262-498-5989
Mailing Address - Fax:
Practice Address - Street 1:608 N 63RD ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-4176
Practice Address - Country:US
Practice Address - Phone:262-498-5989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program