Healthcare Provider Details

I. General information

NPI: 1235395807
Provider Name (Legal Business Name): FERDINAND CINTRON PADILLA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1459 LANEY WALKER BLVD SCHOOL OF DENTISTRY
AUGUSTA GA
30912-1210
US

IV. Provider business mailing address

2501 HENRY ST
AUGUSTA GA
30904-4653
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-2716
  • Fax: 706-721-1893
Mailing address:
  • Phone: 706-414-6904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN013775
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN013775
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: