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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