Provider Demographics
NPI:1740325638
Name:PAYNE, ANTHONY B (DMD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:B
Last Name:PAYNE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 GROVE RD
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-2335
Mailing Address - Country:US
Mailing Address - Phone:508-655-6847
Mailing Address - Fax:
Practice Address - Street 1:MCI-NORFOLK
Practice Address - Street 2:2 CLARK ST.
Practice Address - City:NORFOLK
Practice Address - State:MA
Practice Address - Zip Code:02056
Practice Address - Country:US
Practice Address - Phone:508-660-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19095122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist