Provider Demographics
NPI:1871690420
Name:PAYTON, DONALD CLIFFORD JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:CLIFFORD
Last Name:PAYTON
Suffix:JR
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 1:102 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64724-1402
Mailing Address - Country:US
Mailing Address - Phone:660-476-2197
Mailing Address - Fax:
Practice Address - Street 1:102 W 4TH ST
Practice Address - Street 2:
Practice Address - City:APPLETON CITY
Practice Address - State:MO
Practice Address - Zip Code:64724-1402
Practice Address - Country:US
Practice Address - Phone:660-476-2197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE0135131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice