Provider Demographics
NPI:1730493099
Name:PAYNE, CANDACE COOLEY (DMD)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:COOLEY
Last Name:PAYNE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:LAUREN
Other - Last Name:COOLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:142 VALDIVIA CIR
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-2228
Mailing Address - Country:US
Mailing Address - Phone:925-294-9288
Mailing Address - Fax:
Practice Address - Street 1:4375 1ST ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-4912
Practice Address - Country:US
Practice Address - Phone:925-294-9288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV60461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice