Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | D008321 | AZ |
N | 1223G0001X | General Practice | 30018265 | OH |
N | 213EG0000X | General Practice | 30018265 | OH |
Y | 1223P0700X | Prosthodontist | DEN4608 | ME |
NPI | 1225047806 |
---|---|
Provider Name | Dr. John Wesley Payne II |
First Address | Tucson, AZ 85704-8305 |
Second Address | Portland, ME 04103-2656 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 22/02/2018 |