Provider Demographics
NPI:1316110984
Name:PADBURY AND PADBURY, D.D.S, M.S., P.C.
Entity type:Organization
Organization Name:PADBURY AND PADBURY, D.D.S, M.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:PADBURY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-784-2700
Mailing Address - Street 1:306 W WASHINGTON AVE
Mailing Address - Street 2:202
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2169
Mailing Address - Country:US
Mailing Address - Phone:517-784-2700
Mailing Address - Fax:
Practice Address - Street 1:306 W WASHINGTON AVE
Practice Address - Street 2:202
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2169
Practice Address - Country:US
Practice Address - Phone:517-784-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1223P0300X1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty