Provider Demographics
NPI:1275142481
Name:JOHN, PADEN (DMD)
Entity type:Individual
Prefix:
First Name:PADEN
Middle Name:
Last Name:JOHN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 OFALLON SQ
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-3034
Mailing Address - Country:US
Mailing Address - Phone:636-240-1750
Mailing Address - Fax:
Practice Address - Street 1:31 OFALLON SQ
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-3034
Practice Address - Country:US
Practice Address - Phone:636-240-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4450122300000X
MO20200253011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist