Provider Demographics
NPI:1962506402
Name:PAYNTER, MARY DAVIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:DAVIS
Last Name:PAYNTER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:DAVIS
Other - Last Name:HERRICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:56 HARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-6164
Mailing Address - Country:US
Mailing Address - Phone:502-426-5787
Mailing Address - Fax:
Practice Address - Street 1:8000 WILLIAM G PENNY LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-3739
Practice Address - Country:US
Practice Address - Phone:502-969-2396
Practice Address - Fax:502-969-6901
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7499122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist