Provider Demographics
NPI:1003257379
Name:PADILLA, STEPHANIE ASHLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ASHLEY
Last Name:PADILLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 EUBANK BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3557
Mailing Address - Country:US
Mailing Address - Phone:505-292-2323
Mailing Address - Fax:855-287-5765
Practice Address - Street 1:3809 EUBANK BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3557
Practice Address - Country:US
Practice Address - Phone:505-292-2323
Practice Address - Fax:855-287-5765
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2016-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD3917122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM96500387Medicaid