Provider Demographics
NPI:1225195282
Name:PAYNE, RYAN M (DMD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:M
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 1:3327 S POMPEI AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5069
Mailing Address - Country:US
Mailing Address - Phone:208-855-5079
Mailing Address - Fax:
Practice Address - Street 1:222 W IOWA AVE STE 200
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6814
Practice Address - Country:US
Practice Address - Phone:208-467-3191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-4009122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist