Provider Demographics
NPI:1447794490
Name:PAYNE, REBECCA (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 LONESOME RD.
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448
Mailing Address - Country:US
Mailing Address - Phone:985-626-0160
Mailing Address - Fax:985-727-4459
Practice Address - Street 1:4010 LONESOME RD
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-7085
Practice Address - Country:US
Practice Address - Phone:985-626-0160
Practice Address - Fax:985-727-4459
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA65671223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics