Individual
DR. BRANDON C PAYNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.D.
Contact information
Practice address
4728 EAGLERIDGE CIR STE 110, PUEBLO, CO 81008-2196
(719) 542-4546
(719) 542-4548
Mailing address
4728 EAGLERIDGE CIR STE 110, PUEBLO, CO 81008-2196
(719) 542-4546
(719) 542-4548
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
10136
CO
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
50000
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33987220
—
CO
Enumeration date
02/01/2007
Last updated
11/10/2024
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