Provider Demographics
NPI:1740382944
Name:PADGETT, JAMES D (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:PADGETT
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 1:49 CHESAPEAKE
Mailing Address - Street 2:
Mailing Address - City:MCKENZIE
Mailing Address - State:TN
Mailing Address - Zip Code:38201-2206
Mailing Address - Country:US
Mailing Address - Phone:731-352-5729
Mailing Address - Fax:
Practice Address - Street 1:1934 CEDAR STA
Practice Address - Street 2:
Practice Address - City:MCKENZIE
Practice Address - State:TN
Practice Address - Zip Code:38201
Practice Address - Country:US
Practice Address - Phone:731-352-2605
Practice Address - Fax:731-352-2605
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS25581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
829074OtherUNITED CONCORDIA
TN0038646OtherBLUE CROSS BLUE SHIELD