Provider Demographics
NPI:1407860091
Name:PAYNE, ROBERT W (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
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 1:3015 JEFFERSON ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-2339
Mailing Address - Country:US
Mailing Address - Phone:850-526-2511
Mailing Address - Fax:850-526-5159
Practice Address - Street 1:3015 JEFFERSON ST
Practice Address - Street 2:SUITE D
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-2339
Practice Address - Country:US
Practice Address - Phone:850-526-2511
Practice Address - Fax:850-526-5159
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN62541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice