Provider Demographics
NPI:1144744657
Name:DR. PADDY, PLLC
Entity Type:Organization
Organization Name:DR. PADDY, PLLC
Other - Org Name:STAPLETON CHILDREN'S DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:SMITHWICK
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:443-756-7119
Mailing Address - Street 1:2373 CENTRAL PARK BLVD UNIT 305
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-2301
Mailing Address - Country:US
Mailing Address - Phone:303-399-5437
Mailing Address - Fax:
Practice Address - Street 1:2373 CENTRAL PARK BLVD UNIT 305
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-2301
Practice Address - Country:US
Practice Address - Phone:303-399-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002018251223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO71537856Medicaid