Provider Demographics
NPI:1508947516
Name:PAYNE, JEFFREY BRUCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BRUCE
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 1:40TH AND HOLDREGE STREETS
Mailing Address - Street 2:UNIVERSITY DENTAL ASSOCIATES
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68583-0740
Mailing Address - Country:US
Mailing Address - Phone:402-472-8900
Mailing Address - Fax:402-472-0048
Practice Address - Street 1:40TH AND HOLDREGE STREETS
Practice Address - Street 2:ROOM 137
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68583-0740
Practice Address - Country:US
Practice Address - Phone:402-472-8900
Practice Address - Fax:402-472-0048
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE57641223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE5850OtherBCBS
NEU19658Medicare UPIN
NE5850OtherBCBS