Provider Demographics
NPI:1790855492
Name:PAYRA, EDUARDO S (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:S
Last Name:PAYRA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19304 W. SAN LEANDRO DR.
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321
Mailing Address - Country:US
Mailing Address - Phone:661-250-3811
Mailing Address - Fax:
Practice Address - Street 1:9063 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-1812
Practice Address - Country:US
Practice Address - Phone:818-830-0212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38158122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist