| NPI | 1598332496 |
|---|---|
| Professional Name | PAYTON SOUTHALL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WV 4511) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.026602) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: WV 4511) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2024-06-18 |