Provider Demographics
NPI:1659440105
Name:PADRON, LORENZO MINERVO (DDS)
Entity Type:Individual
Prefix:
First Name:LORENZO
Middle Name:MINERVO
Last Name:PADRON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 COTTONWOOD ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-3603
Mailing Address - Country:US
Mailing Address - Phone:530-661-9276
Mailing Address - Fax:530-662-0965
Practice Address - Street 1:520 COTTONWOOD ST
Practice Address - Street 2:SUITE 11
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3603
Practice Address - Country:US
Practice Address - Phone:530-661-9276
Practice Address - Fax:530-662-0965
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA479801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA47980OtherDENTAL LICENSE NUMBER