Provider Demographics
NPI:1508940446
Name:PADGETT, MELISSA (DDS)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:
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 1:1006 BOARDMAN-CANFIELD RD.
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512
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 1-A
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512
Practice Address - Country:US
Practice Address - Phone:330-726-6700
Practice Address - Fax:330-965-9594
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-02-18711223G0001X
OH0218711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2682539Medicaid