Provider Demographics
NPI:1659032456
Name:DR. JOSE LUIS PADILLA PLLC
Entity Type:Organization
Organization Name:DR. JOSE LUIS PADILLA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:PADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-393-9855
Mailing Address - Street 1:5103 JUNO CT
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-0246
Mailing Address - Country:US
Mailing Address - Phone:956-393-9855
Mailing Address - Fax:
Practice Address - Street 1:4451 S JACKSON RD STE B&C
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-7832
Practice Address - Country:US
Practice Address - Phone:956-393-9855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1841701471OtherPERSONAL NPI