Provider Demographics
NPI:1417176959
Name:PAYNE, JOSEPH P (DDS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:P
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 1:102 WALNUT ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-1121
Mailing Address - Country:US
Mailing Address - Phone:423-756-0481
Mailing Address - Fax:423-265-3103
Practice Address - Street 1:102 WALNUT ST
Practice Address - Street 2:SUITE C
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-1121
Practice Address - Country:US
Practice Address - Phone:423-756-0481
Practice Address - Fax:423-265-3103
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN72541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice