Provider Demographics
NPI:1649488578
Name:PAYNE, RODNEY G (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:G
Last Name:PAYNE
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3668 W 9800 S
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-3260
Mailing Address - Country:US
Mailing Address - Phone:801-260-1515
Mailing Address - Fax:801-260-1691
Practice Address - Street 1:3668 W 9800 S
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-3260
Practice Address - Country:US
Practice Address - Phone:801-260-1515
Practice Address - Fax:801-260-1691
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5360696-99211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics