Provider Demographics
NPI:1083903553
Name:PADGETT, MARY C (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:C
Last Name:PADGETT
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 1:922 MARGARET ST
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-3923
Mailing Address - Country:US
Mailing Address - Phone:715-365-6859
Mailing Address - Fax:715-362-7060
Practice Address - Street 1:922 MARGARET ST
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3923
Practice Address - Country:US
Practice Address - Phone:715-365-6859
Practice Address - Fax:715-362-2060
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33769700Medicaid