Provider Demographics
NPI:1659407005
Name:PADGETT, JAMISON OWENS (DMD)
Entity Type:Individual
Prefix:MRS
First Name:JAMISON
Middle Name:OWENS
Last Name:PADGETT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 SOUTHLEA DRIVE
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590
Mailing Address - Country:US
Mailing Address - Phone:252-756-6882
Mailing Address - Fax:
Practice Address - Street 1:1609 W ARLINGTON BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834
Practice Address - Country:US
Practice Address - Phone:252-752-1111
Practice Address - Fax:252-752-9851
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC78971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice