Provider Demographics
NPI:1467552976
Name:PAYNE, JONATHAN MACK III (DDS MSD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MACK
Last Name:PAYNE
Suffix:III
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6141 SHERRY LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6302
Mailing Address - Country:US
Mailing Address - Phone:214-691-2614
Mailing Address - Fax:214-691-0814
Practice Address - Street 1:6141 SHERRY LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6302
Practice Address - Country:US
Practice Address - Phone:214-691-2614
Practice Address - Fax:214-691-0814
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87061223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics