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Individual
DR. PAYTON SOUTHALL
Active
Individual
DR. PAYTON SOUTHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4511
WV
1223G0001X
General Practice Dentistry
30.026602
OH
1223P0221X
Pediatric Dentistry
4511
WV
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/08/2021
Last updated
06/18/2024
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