Provider Demographics
NPI:1194095091
Name:PADILLA, JORGE (DDS)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:
Last Name:PADILLA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 MINERVA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-5084
Mailing Address - Country:US
Mailing Address - Phone:925-216-7535
Mailing Address - Fax:
Practice Address - Street 1:118 MINERVA WAY
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-5084
Practice Address - Country:US
Practice Address - Phone:925-216-7535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA447541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice