Provider Demographics
NPI:1366114803
Name:DIGGINS, PAYTON RENARD
Entity type:Individual
Prefix:
First Name:PAYTON
Middle Name:RENARD
Last Name:DIGGINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 SUMNER RD
Mailing Address - Street 2:
Mailing Address - City:CARLISLE BARRACKS
Mailing Address - State:PA
Mailing Address - Zip Code:17013-5091
Mailing Address - Country:US
Mailing Address - Phone:706-358-3060
Mailing Address - Fax:
Practice Address - Street 1:450 GIBNER RD
Practice Address - Street 2:
Practice Address - City:CARLISLE BARRACKS
Practice Address - State:PA
Practice Address - Zip Code:17013-5090
Practice Address - Country:US
Practice Address - Phone:717-245-4542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant