Provider Demographics
NPI:1083941314
Name:MELISSA MULLANE PADGETT, DDS, LLC
Entity Type:Organization
Organization Name:MELISSA MULLANE PADGETT, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PADGETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-726-6700
Mailing Address - Street 1:1006 BOARDMAN CANFIELD RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4278
Mailing Address - Country:US
Mailing Address - Phone:330-726-6700
Mailing Address - Fax:330-965-9594
Practice Address - Street 1:1006 BOARDMAN CANFIELD RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4278
Practice Address - Country:US
Practice Address - Phone:330-726-6700
Practice Address - Fax:330-965-9594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300218711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2682539Medicaid