Provider Demographics
NPI:1720203656
Name:PAYNE, KENT W (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:W
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 1:646 W SAN BERNARDINO RD
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722
Mailing Address - Country:US
Mailing Address - Phone:626-332-6291
Mailing Address - Fax:626-339-4968
Practice Address - Street 1:646 W SAN BERNARDINO RD
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722
Practice Address - Country:US
Practice Address - Phone:626-332-6291
Practice Address - Fax:626-339-4968
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA154231223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry