Provider Demographics
NPI:1235117193
Name:PAYNE, ROBERT M (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
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 1:3031 POPLAR CREEK DR SE
Mailing Address - Street 2:301
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49512-5682
Mailing Address - Country:US
Mailing Address - Phone:616-949-6449
Mailing Address - Fax:
Practice Address - Street 1:229 W MAIN ST
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-1638
Practice Address - Country:US
Practice Address - Phone:616-527-2220
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI18154122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist