Provider Demographics
NPI:1023162583
Name:WILLLIAM H PAYNE DDS AND KEVIN DDS DENTAL ASSOCIATES
Entity type:Organization
Organization Name:WILLLIAM H PAYNE DDS AND KEVIN DDS DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:717-246-1085
Mailing Address - Street 1:411 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RED LION
Mailing Address - State:PA
Mailing Address - Zip Code:17356-2412
Mailing Address - Country:US
Mailing Address - Phone:717-246-1085
Mailing Address - Fax:717-246-4472
Practice Address - Street 1:411 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RED LION
Practice Address - State:PA
Practice Address - Zip Code:17356-2412
Practice Address - Country:US
Practice Address - Phone:717-246-1085
Practice Address - Fax:717-246-4472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024024L1223G0001X
PADS018151L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty