Provider Demographics
NPI:1245444272
Name:PAYNE, MICHAEL JOHN II (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:PAYNE
Suffix:II
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 1:2901 WILSHIRE BLVD STE 336
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4912
Mailing Address - Country:US
Mailing Address - Phone:310-828-4451
Mailing Address - Fax:310-828-4582
Practice Address - Street 1:2901 WILSHIRE BLVD STE 336
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4912
Practice Address - Country:US
Practice Address - Phone:310-828-4451
Practice Address - Fax:310-828-4582
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA529121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA571222892OtherBUSINESS TAXPAYER IDENTIFICATION NUMBER