Provider Demographics
NPI:1538785522
Name:PAYNE, CHRISTOPHER MASON
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MASON
Last Name:PAYNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3380 WARM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH JUNCTION
Mailing Address - State:WV
Mailing Address - Zip Code:25442-4781
Mailing Address - Country:US
Mailing Address - Phone:304-707-5146
Mailing Address - Fax:
Practice Address - Street 1:115 S CHARLES ST
Practice Address - Street 2:
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-1613
Practice Address - Country:US
Practice Address - Phone:304-725-4492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV44721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice