Provider Demographics
NPI:1326169715
Name:PAYNE, JOHN H (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
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 1:21760 W 14 MILE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-4005
Mailing Address - Country:US
Mailing Address - Phone:248-646-9561
Mailing Address - Fax:248-932-2281
Practice Address - Street 1:21760 W 14 MILE RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48301-4005
Practice Address - Country:US
Practice Address - Phone:248-646-9561
Practice Address - Fax:248-932-2281
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI129311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice