Provider Demographics
NPI:1205947876
Name:PAYNE, WALTER LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:LEE
Last Name:PAYNE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1919 LATHROP ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-5930
Mailing Address - Country:US
Mailing Address - Phone:907-452-7007
Mailing Address - Fax:907-456-5834
Practice Address - Street 1:1919 LATHROP ST
Practice Address - Street 2:SUITE 211
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5930
Practice Address - Country:US
Practice Address - Phone:907-452-7007
Practice Address - Fax:907-456-5834
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice