MEDICARE: THOMAS B PADGETT DMD

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
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	0438000033	VA
2	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	0438000033	VA

General Provider Information

NPI Number	:	1942308143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS B PADGETT DMD

Provider Business Mailing Address
First Line	:	1680 HUGUENOT RD
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23113-2427
Country	:	US
Telephone Number	:	804-379-7120
Fax Number	:	804-379-9835

Provider Business Practice Location Address
First Line	:	1680 HUGUENOT RD
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23113-2427
Country	:	US
Telephone Number	:	804-379-7120
Fax Number	:	804-379-9835

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	03/18/2019

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