Provider Demographics
NPI:1023223336
Name:PADBURY, ALLAN DALE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:DALE
Last Name:PADBURY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 W WASHINGTON AVE
Mailing Address - Street 2:202
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2169
Mailing Address - Country:US
Mailing Address - Phone:517-784-2700
Mailing Address - Fax:
Practice Address - Street 1:306 W WASHINGTON AVE
Practice Address - Street 2:202
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2169
Practice Address - Country:US
Practice Address - Phone:517-784-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010088691223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics