Organization
JMJ NAMPA LLC
Active
Organization
JMJ NAMPA LLC
Active
Other names
Nampa Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL PAYNE D. PAYNE DMD (PRESIDENT)
(208) 884-4466
Entity
Organization
Contact information
Practice address
914 12TH AVE RD, NAMPA, ID 83686
(208) 468-9191
Mailing address
3289 N TOWERBRIDGE WAY, MERIDIAN, ID 83646-8347
(208) 884-4466
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
=========
PEDIATRIC DENTIST
ID
Enumeration date
09/19/2018
Last updated
05/08/2020
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