Individual
TRACI MICHELLE PAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
300 W BROADWAY, SUITE 6, COUNCIL BLUFFS, IA 51503-9078
(712) 256-9151
(712) 325-0288
Mailing address
300 W BROADWAY, SUITE 6, COUNCIL BLUFFS, IA 51503-9078
(712) 256-9151
(712) 325-0288
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
03217
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0188946
—
IA
01
—
1114906906
GROUP NPI
—
Enumeration date
04/23/2009
Last updated
04/23/2009
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