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NPI Code Detail

MEDICARE: RICHARD PADRON DDS

MEDICARE: RICHARD PADRON DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist042992NY

General Provider Information

NPI Number : 1275514341
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD PADRON DDS
Provider Business Mailing Address
First Line : 10205 N RIVA RIDGE LOOP
Second Line : US ARMY DENTAL ACTIVITY ATTN CREDENTIALS
City : FORT DRUM
State : NY
Zip : 13602-5005
Country : US
Telephone Number : 315-772-4342
Fax Number : 315-772-9692
Provider Business Practice Location Address
First Line : USA MEDDAC
Second Line : 11050 MOUNT BELVEDERE BLVD
City : FORT DRUM
State : NY
Zip : 13602-5005
Country : US
Telephone Number : 315-772-4342
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2005
Last Update Date : 10/07/2024

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