Provider Demographics
NPI:1891784260
Name:PADULA, DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:PADULA
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 1:7260 UNIVERSITY AVE NE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-3126
Mailing Address - Country:US
Mailing Address - Phone:763-571-1070
Mailing Address - Fax:
Practice Address - Street 1:7260 UNIVERSITY AVE NE
Practice Address - Street 2:SUITE 115
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-3126
Practice Address - Country:US
Practice Address - Phone:763-571-1070
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice