Provider Demographics
NPI:1578689659
Name:PAYNTER FAMILY DENTISTRY, PC
Entity Type:Organization
Organization Name:PAYNTER FAMILY DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:M
Authorized Official - Last Name:PAYNTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-666-7000
Mailing Address - Street 1:445 W POWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7048
Mailing Address - Country:US
Mailing Address - Phone:503-666-7000
Mailing Address - Fax:503-669-2080
Practice Address - Street 1:445 W POWELL BLVD
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7048
Practice Address - Country:US
Practice Address - Phone:503-666-7000
Practice Address - Fax:503-669-2080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD87201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty