Provider Demographics
NPI:1346570215
Name:MICHAEL J. PAYNE II, DDS. INC.
Entity Type:Organization
Organization Name:MICHAEL J. PAYNE II, DDS. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-828-4451
Mailing Address - Street 1:2901 WILSHIRE BLVD STE 336
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4912
Mailing Address - Country:US
Mailing Address - Phone:310-828-4451
Mailing Address - Fax:310-828-4582
Practice Address - Street 1:2901 WILSHIRE BLVD STE 336
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4912
Practice Address - Country:US
Practice Address - Phone:310-828-4451
Practice Address - Fax:310-828-4582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA529121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty