Provider Demographics
NPI:1629429444
Name:PAYLOR, JERAMIAH (DDS)
Entity Type:Individual
Prefix:
First Name:JERAMIAH
Middle Name:
Last Name:PAYLOR
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 1:9415 JOYCE WAY
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80007-7501
Mailing Address - Country:US
Mailing Address - Phone:720-635-2684
Mailing Address - Fax:
Practice Address - Street 1:18068 W 92ND LN UNIT 100
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80007-8162
Practice Address - Country:US
Practice Address - Phone:720-635-2684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2028761223S0112X, 1223G0001X
CODEN.00202876122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice