Provider Demographics
NPI:1962687095
Name:W. LEE PAYNE, DDS, PC
Entity Type:Organization
Organization Name:W. LEE PAYNE, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-452-7007
Mailing Address - Street 1:1919 LATHROP ST STE 211
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-5942
Mailing Address - Country:US
Mailing Address - Phone:907-452-7007
Mailing Address - Fax:907-456-5834
Practice Address - Street 1:1919 LATHROP ST STE 211
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5942
Practice Address - Country:US
Practice Address - Phone:907-452-7007
Practice Address - Fax:907-456-5834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty