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General NPI Number Information
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NPI Number | 1316110984
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Entity Type | Organization
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Legal Business Name | PADBURY AND PADBURY, D.D.S, M.S., P.C.
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Dates
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Enumeration Date | 04/03/2008
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Last Update Date | 04/03/2008
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Provider Practice Location Address
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Address Line | 306 W WASHINGTON AVE 202
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City | JACKSON
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State | MI
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Zip | 49201-2169
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Country | US
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Telephone | 517-784-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 306 W WASHINGTON AVE 202
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City | JACKSON
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State | MI
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Zip | 49201-2169
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Country | US
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Telephone | 517-784-2700
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Fax |
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Authorized Official
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Title or Position | PERIODONTIST
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Name | DR. ALLAN DALE PADBURY JR.
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Credential | D.D.S.
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Telephone | 517-784-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 1223P0300X
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License Number State | MI
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