Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DD3917 | NM |
NPI | 1003257379 |
---|---|
Provider Name | Dr. Stephanie Ashley Padilla |
First Address | Albuquerque, NM 87111-3557 |
Second Address | Albuquerque, NM 87111-3557 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2013 |
Last Update Date | 25/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
96500387 | (05) | NM |