| Brandon C. Payne D.d.s., M.d., P.c. | |
|
4728 Eagleridge Cir Ste 110 Pueblo CO 81008-2196 | |
| (719) 542-4546 | |
| (719) 542-4548 |
| Full Name | Brandon C. Payne D.d.s., M.d., P.c. |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 4728 Eagleridge Cir Ste 110, Pueblo, Colorado |
| Authorized Official Name and Position | Brandon C Payne (PRESIDENT) |
| Authorized Official Contact | 7195424546 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Brandon C. Payne D.d.s., M.d., P.c. 4728 Eagleridge Cir Ste 110 Pueblo CO 81008-2196 Ph: (719) 542-4546 | Brandon C. Payne D.d.s., M.d., P.c. 4728 Eagleridge Cir Ste 110 Pueblo CO 81008-2196 Ph: (719) 542-4546 |
| NPI Number | 1790993376 |
|---|---|
| Provider Enumeration Date | 05/18/2007 |
| Last Update Date | 11/10/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790993376 | NPI | - | NPPES |
| 33987220 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 10136 (Colorado) | Primary |
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