Provider Demographics
NPI:1386628725
Name:PAYNE, RANDALL H (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
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 1:5140 N UNION
Mailing Address - Street 2:PERFECT TEETH UNION & ACADEMY PC
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918
Mailing Address - Country:US
Mailing Address - Phone:719-260-6093
Mailing Address - Fax:719-260-2339
Practice Address - Street 1:5140 N UNION
Practice Address - Street 2:PERFECT TEETH UNION & ACADEMY PC
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918
Practice Address - Country:US
Practice Address - Phone:719-260-6093
Practice Address - Fax:719-260-2339
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO56761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice