Individual
JAELA PAYNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1 KNEELAND ST, BOSTON, MA 02111-1527
(617) 636-6828
Mailing address
156 HERRINGS GREEN LOOP APT 205, MOORESVILLE, NC 28117-0187
(317) 654-3099
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
14388
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/31/2024
Last updated
07/31/2025
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