Provider Demographics
NPI:1174587315
Name:PAYTON, KEVIN LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LYNN
Last Name:PAYTON
Suffix:
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 1:5531 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4649
Mailing Address - Country:US
Mailing Address - Phone:954-227-4892
Mailing Address - Fax:954-227-4894
Practice Address - Street 1:100 NW 82ND AVE
Practice Address - Street 2:SUITE 101-102
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-7809
Practice Address - Country:US
Practice Address - Phone:954-475-9840
Practice Address - Fax:954-370-0500
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN116661223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL592043705OtherTAX ID
FL63054XOtherMEDICARE ID
FL072006200Medicaid
FL592043705OtherTAX ID
FL63054XOtherMEDICARE ID
FL072006200Medicaid
FL21328AMedicare PIN
FL21328BMedicare PIN