Healthcare Provider Details

I. General information

NPI: 1144744657
Provider Name (Legal Business Name): DR. PADDY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2373 CENTRAL PARK BLVD UNIT 305
DENVER CO
80238-2301
US

IV. Provider business mailing address

2373 CENTRAL PARK BLVD UNIT 305
DENVER CO
80238-2301
US

V. Phone/Fax

Practice location:
  • Phone: 303-399-5437
  • Fax:
Mailing address:
  • Phone: 303-399-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number00201825
License Number StateCO

VIII. Authorized Official

Name: DR. ALFRED PATRICK SMITHWICK III
Title or Position: OWNER
Credential: DDS
Phone: 443-756-7119