# LARRY G PAYNE DDS LC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Waterloo Family Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255884425
- **Authorized official:** DIANNA J PAYNE (VICE PRESIDENT/ OFFICE MANAGER)
- **Authorized official phone:** (260) 837-2138

## Contact information

- **Practice address:** 605 S WAYNE ST, WATERLOO, IN 46793-9472
- **Practice address phone:** (260) 837-2138
- **Practice address fax:** (260) 837-7481
- **Mailing address:** 605 S WAYNE ST, WATERLOO, IN 46793-9472
- **Mailing address phone:** (260) 837-2138
- **Mailing address fax:** (260) 837-7481

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | — |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 07/25/2016
- **Last updated:** 07/25/2016