Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 2901008869 | MI |
NPI | 1023223336 |
---|---|
Provider Name | Dr. Allan Dale Padbury |
First Address | Jackson, MI 49201-2169 |
Second Address | Jackson, MI 49201-2169 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2007 |
Last Update Date | 08/07/2007 |