Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 048674-1 | NY |
NPI | 1114098142 |
---|---|
Provider Name | Josue Padilla |
First Address | Pittsford, NY 14534-4200 |
Second Address | Pittsford, NY 14534 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 08/07/2007 |