Provider Demographics
NPI:1124135371
Name:PADEN, MICHELLE JOY-THORNBERG (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:JOY-THORNBERG
Last Name:PADEN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 W DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-1438
Mailing Address - Country:US
Mailing Address - Phone:574-277-2220
Mailing Address - Fax:
Practice Address - Street 1:605 W DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1438
Practice Address - Country:US
Practice Address - Phone:574-277-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013249A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics