Provider Demographics
NPI:1558412015
Name:PADEN, MARK ROBIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ROBIN
Last Name:PADEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3609 COFFEE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-1100
Mailing Address - Country:US
Mailing Address - Phone:209-577-3429
Mailing Address - Fax:209-575-0724
Practice Address - Street 1:3609 COFFEE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-1100
Practice Address - Country:US
Practice Address - Phone:209-577-3429
Practice Address - Fax:209-575-0724
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA770256552OtherEMPLOYER ID NUMBER