Provider Demographics
NPI:1073540357
Name:PADILLA, RICARDO JOSE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:JOSE
Last Name:PADILLA
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:UNC ADAMS SCHOOL OF DENTISTRY CB #7450
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-0001
Mailing Address - Country:US
Mailing Address - Phone:919-537-3152
Mailing Address - Fax:919-843-6508
Practice Address - Street 1:3040 MANNING DRIVE OLD DENTAL BUILDING
Practice Address - Street 2:CB 7450
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7450
Practice Address - Country:US
Practice Address - Phone:919-966-2751
Practice Address - Fax:919-843-6508
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC125331223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902EGMedicaid
NC902EGOtherBLUE CROSS BLUE SHIELD NC
NC5901529Medicaid
NC5901529Medicaid
NC89902EGMedicaid