Glenn Reed Payne, DDS
Individual provider Active NPI Dentist · Orem, UT
NPI 1477581833 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1477581833
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 289969 (UT)
- Practice address
- 440 W 800 N
Orem, UT 84057-3728 - Phone
- (801) 764-9444
- NPI assigned
- Jun 28, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 289969 | UT | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Canyon Gate Dental Care LLC | Past | Accepting new patients | |
| Nicolas K. Young, D.M.D., Inc. | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 289969 | UT | Yes |
Addresses
Primary practice location
440 W 800 N
Orem, UT 84057-3728
Mailing address
440 W 800 N
Orem, UT 84057-3728
Phone (801) 221-4992
Other providers in Orem, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.