Brandon C. Payne D.D.S., M.D., P.C.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

10136 Issued in CO

Legal business name

BRANDON C. PAYNE D.D.S., M.D., P.C.

Practice address

4728 Eagleridge Cir Ste 110
Pueblo, CO 81008-2196

Phone

(719) 542-4546

Fax

(719) 542-4548

NPI assigned

May 18, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brandon C Payne, MD, DDS

Title

President

Phone

(719) 542-4546

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731196800000",
    "number": "1790993376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4728 EAGLERIDGE CIR STE 110",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082196",
            "telephone_number": "719-542-4546",
            "fax_number": "719-542-4548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4728 EAGLERIDGE CIR STE 110",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082196",
            "telephone_number": "719-542-4546",
            "fax_number": "719-542-4548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRANDON C. PAYNE D.D.S., M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2024-11-10",
        "certification_date": "2024-11-10",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "719-542-4546",
        "authorized_official_credential": "MD, DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CO",
            "license": "10136",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33987220",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Oral and Maxillofacial Surgery (Dentist) in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.