Provider Demographics
NPI:1083711295
Name:PADNER, WILLIAM LEONARD III (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LEONARD
Last Name:PADNER
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 CHESTNUT STREET
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603
Mailing Address - Country:US
Mailing Address - Phone:570-752-2071
Mailing Address - Fax:570-752-4692
Practice Address - Street 1:205 CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603
Practice Address - Country:US
Practice Address - Phone:570-752-2071
Practice Address - Fax:570-752-4692
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028567L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014331240001OtherDEPARTMENT OF PUBLIC WELF
PA0014331240001Medicaid
196470OtherUNITED CONCORDIA
196470OtherBLUE SHIELD OF PA