Provider Demographics
NPI:1043615495
Name:PADILLA, MARK (DDS, MS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:PADILLA
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8756 TEEL PKWY
Mailing Address - Street 2:SUITE 336
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4414
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8756 TEEL PKWY
Practice Address - Street 2:SUITE 336
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4414
Practice Address - Country:US
Practice Address - Phone:972-712-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX280351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics