Provider Demographics
NPI:1730103136
Name:PAYNE, EMILY INGRAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:INGRAM
Last Name:PAYNE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 SOUTHLAKE PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3317
Mailing Address - Country:US
Mailing Address - Phone:205-988-5656
Mailing Address - Fax:205-988-3972
Practice Address - Street 1:4515 SOUTHLAKE PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-3317
Practice Address - Country:US
Practice Address - Phone:205-988-5656
Practice Address - Fax:205-988-3972
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD.00054981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice