Provider Demographics
NPI:1952681298
Name:PADILLA, ELIZABETH GARNETA (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:GARNETA
Last Name:PADILLA
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:GARNETA
Other - Last Name:BARNUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2005 KNIGHT AVE. BLDG H
Mailing Address - Street 2:NAVY MEDICINE SUPPORT COMMAND ATTN:MEDICAL SUPPORT STAF
Mailing Address - City:JACKSONVILLE,
Mailing Address - State:FL
Mailing Address - Zip Code:32212-0140
Mailing Address - Country:US
Mailing Address - Phone:202-762-3194
Mailing Address - Fax:
Practice Address - Street 1:NMCS BDC
Practice Address - Street 2:2310 CRAVEN STREET
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92136-5000
Practice Address - Country:US
Practice Address - Phone:619-556-8248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA623149681122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist